Welcome to Pushing The Limits, the show that helps you reach your full potential with your host Lisa Tamati, brought to you by lisatamati.com.
Lisa Tamati: You're listening to Pushing The Limits with Lisa Tamati, your host. I have a fantastic gift again for you today. Gosh, I managed to come up with some amazing people. So I have the guest Dr Colin Dombroski, who is a pedorthist and expert on everything foot. He's known as the foot specialist. He is the author of two books, Healthy Strong Feet, and The Plantar Fasciitis Plan. He's a researcher, and also has a shoe—a specialist running shoe shop. He knows everything about the cutting edge of foot health.
So this is a topic that's really important, obviously, for all the runners listening out there. Or if you're having any sort of issues with your feet, maybe you're dealing with plantar fasciitis, maybe you have to have orthotics, or you've got arthritis, or you've got bunions, or you've got problems with your Achilles or further up the kinetic chain, then this is the episode for you because we're going to be talking about the cutting edge of science. Dr Colin is really up on the latest thing. He has all the fancy gadgets in his lab that he does. And so it's a really, really interesting conversation that I have with Dr Colin.
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Right, over to the show now with Dr Colin Dombroski.
Lisa Tamati: Well, hello, everyone. Welcome back to Pushing The Limits. It's your host, Lisa Tamati here. And today I have Colin Dombroski with me, all the way from Ontario in Canada. So welcome to the show, Colin. Fantastic to have you.
Dr Colin Dombroski: Thanks so much for having me.
Lisa: It's really, really exciting. So I am going to be talking to you today about feet. You are the foot guy. You are known as the foot guy. Colin, can you give us a bit of a brief background, why are you known as the foot guy?
Dr Colin: Well, I mean, I'm a Canadian certified pedorthist first and foremost. So I'm trained in both the design and the manufacturer of custom foot orthotics, foot orthotics in general, footwear and lower extremity therapy care, and how those things interact to get people better. And so, we started that back in 2002. And since then, I've gone on to do PhD work in Health and Rehabilitation Science, and research and everything from the basic 3D printings of orthotics to how the foot’s actually moving in a shoe using things like a biplanar fluoroscopy and CT imaging to really understand what's actually going on, as opposed to just kind of guessing and thinking about it or looking at video without actually being able to see inside the shoe.
And so we've seen tens of thousands of patients. We've worked with people over the last 20 years, really working to get them back up and on their feet and doing the things that they want to do to stay healthy. And for some people, it's as simple as walking around the block and for other people it's going to the Olympics in Tokyo.
Lisa: Wow, fantastic. So you're deep into the science...
Dr Colin: Yes.
Lisa: ...of the absolute cutting edge of what we can do now for foot issues and optimising foot health. So tell us a little bit about some of the fancy stuff that you can do, like, how that—you said there you can look into the inside a shoe or...
Dr Colin: Yes.
Lisa: ...rather than just looking at video. How does that work?
Dr Colin: I'll tell you on the research side, there's all kinds of fancy stuff that we were able to do. And so, right now I have an academic appointment through Western University in the School of Physical Therapy. So, I'm lucky enough to be able to do research in what I do specifically. So—and we can do that in a couple of different ways. One is that we actually have a full 3D motion analysis lab at our main business in London Ontario. So it's seven Vicon cameras, much like the way you would see motion analysis for video games or for the movies.
Dr Colin: Well, we use that to study how the lower extremity works in the human body. And so we can either put markers on the foot and cut windows into the shoe, so we can see how things move. That's one way to do it. The other way that we've done it is working with another lab called the wobble lab, and they have two movie x-rays, or what's called biplanar fluoroscopy. And then what we can do is have a CT of somebody's foot, we can take those bones out, we can map them in three-dimensional space. And at 17 times per second, we can move that bone model on top of the actual movie x-ray model to understand what's happening to the foot and the bones in real-time in a shoe, under different circumstances, whether that's no orthotic, orthotic, and we can compare that to their walking barefoot as well.
Lisa: That is insane Colin. I have no idea.
Dr Colin: Yes. it's a cool thing. And if you go on the website, if you go on—I think we have a fluoroscopy video up on stuff about feet. But if we don't, there's certainly one up on the research section of SoleScience, and you're able to actually watch, you can see what we're looking at through this thing.
Dr Colin: And it's really cool to know. And what's really interesting when we look at this stuff is that we wanted to know when we make somebody an orthotic. What's the best way to do that for someone? There's different ways that we can capture somebody's foot, whether we use a foam or a wax method or a plaster mould of somebody's foot, we wanted to know kind of based on a couple of different styles, which one might actually control the motion of their foot a bit better. And we were able to show that one was more effective than another—made a small amount with a very specific foot type.
So, if you have a flatter foot, there are ways of making it that are more effective. But what was really interesting out of that was to look at what was actually happening with the foot when someone was just walking barefoot, when they were just walking in their shoe, or when we put an orthotic in there? Because you know if I can go on a bit of a tangent, there's lots of scary stuff on the internet these days about how, ‘Oh, you don't want to walk in shoes and orthotics because it makes you act like you're walking in a cast. And why would you want to do that'?
Well, what's really interesting is that when we looked at someone's foot walking barefoot, and we compared that to the most supportive thing that we use, they still kept up to 96% of their original motion.
Dr Colin: So, think about that for a second, 96% or one motion.
Dr Colin: So, you're really at that point, if someone's keeping that much of their original range of motion, you really have to wonder, ‘What are we actually doing with these things?’ And I'm going to argue that it's more than just the shoe on someone's foot. It's more than just the device in that shoe, that there could be a lot more actually going on with these things than we fully understand even though we have the best research methods to be able to look at it.
Lisa: That's amazing. I mean, I'm really, really interested because with orthotics, I've recently gone and got my mum an orthotic and you don't know my mum's story. But she had a massive aneurysm five years ago, has dropped foot on the right side, incredible rehabilitation journey, written a book on it. But we're not having such success with the orthotic yet. We are having success with a Dictus where it's helping lift her foot. And I've had in the past two experiences with orthotics when I've had different issues, like, I can't remember now what specifically, I think it was plantar fasciitis. And I've tried different things, admittedly a while ago, and things have obviously moved on. But I haven't had that much success.
So I'm like, as a running coach, I should know more about the latest in science as far as orthotics go. And whether they're my initial reaction back then was, ‘Well, I don't think orthotics are really working for a lot of people’. That's been the feedback from other people as well. So obviously, the science has moved forward and it is offering new insights and you can actually see in real-time what our bones are doing. I mean, it's just absolutely mental, that's crazy and cool. So do you think—isn't it like walking around with a cast on your foot? We've got this whole barefoot craze that's been in the last few years and then we've got brands like Hoka One One coming out with really cushions. So, I think people are a little bit confused as to what they should be doing.
Dr Colin: Yes, and rightfully so.
Lisa: Our orthotic is good. Our orthotics in general is—can we generalise when it's very specific.
Dr Colin: Nope. Not at all. We can’t generalise it all and that's the problem when it comes to this stuff is that people are trying to fit everybody into a box. And saying that either it's really good, or it's really bad. It’s either of those things? Like, to the end of the day, if you really need them, if you have rheumatoid arthritis, and you're unable to walk around the block, and I'm able to get you active again, they're really good for you.
Lisa: Yes, absolutely.
Dr Colin: Right? But if you have no risk factors, if you have no biomechanical abnormalities, if you have no foot deformities and no other issues, then what's the benefit of wearing them at the end of the day? And so to that end of things, a lot of the time, I feel as though we're missing the middle ground. We're missing the fact that people can use these things, either as a tool to help them with recovery and performance that we can then work to wean them off, if they so choose, or if they need to be, or we use them because there's a real thing where structure dictates function and injury.
But again, why are we looking to see whether or not people are either yes or no, off or on? It's more of a continuum. And I kind of like to look at people and the fact that over on this end of the spectrum, here, you've got people who are so gifted biomechanically that they can do anything they want to do, despite doing it wrong. They can go couch to marathon in old worn-out shoes with poor sleep with bad nutrition, and they can do it and they don't get hurt. And you've got people on the other end of the spectrum that can do everything, right, and work with the best coaches and get the best equipment and eat and sleep and everything else. But they're plagued with injury, right?
Most people are going to be somewhere in the middle, the question though, so, which side of the spectrum do you lie more towards? And that's where I feel my job comes in, is to figure out where that is, and then how to appropriately apply these things, whether or not you actually need them. And I build a business on telling people when they don't need them.
Lisa: That's brilliant.
Dr Colin: And when they don't need them anymore. So, it's actually quite shocking when someone comes into my office for their ninth orthotic, and I say, ‘Well, tell me about it'. And so they—we talk about stuff, and we come to the conclusion that they just don't need them anymore.
And they're shocked, they think that these things are like a lifelong sentence. And they're not. For some people, they are the difference between being able to be active or not. And for other people, there's simply a tool, and we use that tool appropriately, and we remove it.
Lisa: That is absolutely gold, Colin. And what a fantastic approach in, like, working with people with disabilities and stuff, I know there are definitely times when we do need them, and they're going to benefit and it is very much about the skill of the person who's fitting the orthotic and knows, obviously, what they're doing. And there’s a lot of advertising out there; rubbish sort of advertising that you see with different standard gum, pick it off the shelf type things, what's your opinion on those types of orthotics?
Dr Colin: Well, I mean, if those—so, if something like that, like if an over the counter device works for you, for—let's say you have a mild case of metatarsalgia. Let's say you have a small ache in the front part of your foot when you're active, and you've done all the rest of the conservative therapy things. You're strong, you're flexible, everything else is ticked off, and you're still not doing well. Sometimes removing that little bit of mechanical stress can be enough that allows the tissues to heal and you can move on. Right? So in those cases, yes, they work quite well.
But in some cases, if you have a foot type that doesn't match up with that shaped plastic that's pushing against your foot, it might not work so much. And kind of to your point where you were saying you had them for plantar fasciitis before, and they just didn't work for you, it could be a multitude of reasons why they didn't work for you. And we see that all the time.
And if someone's not getting the right kind of results, it could be that they just need to be adjusted. But then some people don't believe that they need to be adjusted. They believe your foot functions best, one particular way. And they say, ‘Here, this is for you. This is the way it should be, get used to it'.
Lisa: And then it's the whole side of: you should be doing strengthening exercises and rolling and stretching. What's your take on the whole on that side of it? So the rehabilitation side of it as opposed to the orthotic side of the equation?
Dr Colin: Well, so my—the way that we teach about orthotics is that orthotics for some conditions are not a first line treatment unless you have significant risk factors. If you're diabetic, then yes, 100% we're making you orthotics. But for a lot of people especially let's take plantar fasciitis for instance. If you come to me and you've had plantar fasciitis only for a few weeks, there is a whole host of other therapies that you can try before you even need to think about that. Is removing the stress off the tissue, the strain off the tissue with the device and footwear appropriate? Heck yes, it is. But there are other things that you need to look at first before you even go down the route of orthotics which is actually why I wrote my first book. And it's to tell people the things that they can do at home to be able to get themselves better for four to six weeks before they have to see somebody like me to think about orthotics.
Lisa: Okay, so what was the title of that book, Colin?
Dr Colin: Oh, it's called The Plantar Fasciitis Plan.
Lisa: The Plantar Fasciitis Plan and that is available on Amazon?
Dr Colin: Yes.
Lisa: Okay, so in New Zealand, we might struggle with Amazon, but we don't have Amazon down here, believe it or not.
Dr Colin: I have no idea.
Lisa: We can access it, but some things can ship from over the air and some not so. But we'll put the links in the show notes for sure for those listening who are overseas and want to read that book. Okay, so you mentioned...
Dr Colin: And to speak to your last question...
Dr Colin: ...which was, what do you think about the whole foot strengthening part of it?
Dr Colin: I think it's very important, I think that a lot of people have lost the ability to connect with their brain and their feet, and they need to get that ability back, it's shocking how many people I see that can do something as simple as move their toes, or lift their arch, or do some of the simple things that they need to do to make feet work as feet. Right? And so, getting them back to that foot connection is only a positive thing. Like, the only good things are going to come out of that.
Lisa: So, is this like, is this a problem of the modern human because we've walked around in shoes. Did humans, before shoes come along, did we all have great feet? Strong powerful feet because we were barefoot from the get go? So is this a problem of the modern human but like with—I've just done a couple of episodes on breathing and the way that we are chewing is affecting our structure of our mouth and therefore we're not having such good breathing and so on. Is that similar sort of case?
Dr Colin: I really think that when you talk to a question about that, it's really hard to compare those two things because we're just not there right now. You know what I mean? So, yes, if we didn't wear clothes, and we didn't drive cars, and we didn't eat the way that we did, yes, things would be different than where they are. But like, we drive our cars to go five blocks down the street to get to Starbucks, we don't walk. So, that alone is just as deleterious as footwear that doesn't fit you properly.
So when it comes to shoes, again, there's lots of scariness out there on the internet, talking about how these things, again, make you walk like your cast or is deforming your feet. And yes, I would agree that a poorly fit shoes that are way too tight cramming your toes, putting stress on nerves and tissues certainly can be a bad thing for you. But do I think that there's this gigantic conspiracy out there that's making the collective feet of the world less strong and everything else? No, I really don't, to that end. And again, as a recovery tool, they can be marvellous things if done correctly.
Lisa: Yes, it's a really good approach. I mean, it reminds me of my dad's feet. My dad who recently passed, unfortunately. But my dad had the most amazing, strong, powerful feet, he grew up in the first 13 years of life and not wearing shoes. Came from a very humble background with eight children, and they only had one pair of gumboots in the family. So he grew up with these incredibly powerful feet.
By the time he was in his 50s, 60s, 70s, and 80s, he could walk around barefoot all day, never have any sort of problems. The state of his heels weren't the best. But muscular feet, really strong powerful feet, because he didn't wear shoes until he was older and then still like to go barefoot whenever possible, actually connected to the earth, weed garden all day, and their feet at the most jungles. So I did see it in that. Quite the effects of having that real connection to Mother Earth if you like in developing those sort of strong muscles in our feet.
And then on the other side of the equation. I see people with diabetics or close to being pre-diabetic problems with extremely tender feet and poor circulation in the feet and their feet are just not moving well and have always been in shoes. So it's like opposite ends of the scale via. So, where was I going with this? There's a real broad range of where people are at. Another thing that I think is to consider is women in high heeled shoes, what's your take on that sort of a problem? Like, were lifting your heels up and having a shortened calf. And that's sort of a problem.
Dr Colin: Well, I mean, that for too long of a period of time just gives you a whole myriad of problems from metatarsalgia, and progressing bunion issues, and nerve problems, and chronically short Achilles because of that shortening specifically, yes. I mean, we see that all the time. I'm very much a fan of moderation when it comes to these things.
And so for a lot of my patients, if they want to spend an evening, every now and again, where they're primarily sitting in a pair of heels, then I feel as though the trade-off for what they get out of that is okay, comparatively. Again, it's not putting everything into a box of good or bad, but it's looking at it holistically.
Lisa: Brilliant. I think it's a really good approach.
Dr Colin: Yes, if you're a retail worker, and you're spending 10 hours a day, on your feet, heels are definitely not the thing you want to be wearing.
Lisa: Yes, you've got to sacrifice the elegance, ladies. Sometimes you help that little pushes.
Dr Colin: A little bit sometimes. And you know where I end up seeing that a lot? It’s in lawyers. A lot of my patients who are lawyers. There is definitely a culture of dress code and professionalism that comes from wearing heels. And I see a lot of injured lawyers because of that, specifically.
Lisa: Isn't that interesting? So yes, really take heed because I do think doing that on a daily basis, yes. The odd night out in a pair of heels to look elegant is fine, but not doing it every single day, were you really shortening, I mean, just, I'm always sort of relating things back to my life. But with mum having aneurysm, being bedridden pretty much for 18 months before we could get her standing. And I didn't understand at the beginning about drop foot, I missed the boat. And by the time I realised what drop foot was, that had happened very, very quickly, that her foot was now dropped until we're still working on that right through now, to be able to lift set front of the foot up and having to use a Dictus in her case, which lifts the front of the foot up. So it happens very—it happens quicker than what you think.
Dr Colin: It can, certainly. Yes. Now the brace that your mum's using, do you mind if I asked you a quick question? Is she using an over-the-counter one or a custom one?
Lisa: So it's an over-the-counter Dictus one as I didn't know there was such a thing as a customised Dictus. So it's just a leather strap that goes around with a rubber that goes over inside these two little hooks at the bottom of the shoes that pulls the shoe up. So is there something better, Colin?
Dr Colin: Well, so, take a look for something called an Allard ToeOff AFO. And we use them a lot in clinics for patients with drop foot and they're actually designed to be to run marathons and events and they're quite robust.
Lisa: Okay, I’ll take note of that.
Dr Colin: And it might be a great training tool too. They're very light. You should wear them under a pair of pants. A lot of people like the fact that they don't see the direct brace.
Lisa: Yes, yes. Yes, exactly. This one's quite ugly. So, is it Allard?
Dr Colin: A-L-L-A-R-D.
Lisa: Oh, brilliant.
Dr Colin: So as in Allard ToeOff.
Lisa: Allard ToeOff, I will check that out. See, this is a selfish reason why I get to talk to experts.
Dr Colin: There we go.
Lisa: Because you never know when it's gonna help somebody you know? It's fantastic. I'll check that one out. Yes, because that is a real problem. And there's so many—this is not a rare thing, drop foot. It's a very, very common thing with people with strokes and aneurysms and the like.
Dr Colin: It is.
Lisa: So, there's a lot of people dealing with it so going into the rehabilitation side of things. We have a shoe that has a rocker so she's able to toe-off slightly better in that rocker and keep her center of mass moving forward. Rather than sitting really back which she was doing. So yes, so I'm always looking for the next best thing for my mum from the show. So, appreciate that.
Dr Colin: No problem. And since you're a runner and all that stuff, the Asics Metaride is my favourite carbon shoe rocker. We've got so many people who really require surgery, fusions, things like that because of osteoarthritic toes or ankles or mid feet that can get into a shoe like that.
Dr Colin: And for people who are that age, they're not nearly as flashy looking as some of the other carbon rockered shoes that are available.
Lisa: Yes, but who cares as long as they function properly. Okay, Asics Metaride. Okay, we'll check those one out too. Now let's jump ship and change direction a little bit and go into running specific injuries. So we did touch briefly on playing to the shortest. But what are some of the common injuries that you see? And what are some of the ways that we can prevent? And how does it have a knock-on effect? Like what happens in your feet, knocks on the kinetic chain, doesn't it?
Dr Colin: Of course. Yes. So what I take a look at, the one of the biggest things are going to be mismatches between the style of foot that somebody has and their mechanics and the kind of shoe they wind up getting into. And so there's nothing like being able to mismatch the way that your foot wants to move, and then a shoe that's going to either work completely and pushing it in the same direction. So for instance, if you're a supinator, where your foot rolls to the outside, and then you get into an anti-pronation shoe, which a lot of people are—there's actually been research to show that runners are poor judges of their own foot type.
Dr Colin: And if they get into that kind of footwear that makes them into more of a supinator. I can't tell you how many lateral column foot pain problems we see and perennial overuse problems and things like that. So simply mismatching your footwear to what your foot is doing can be one of them.
Lisa: Okay. Getting on and off the shelf is not, and diagnosing yourself is probably not a good idea if you're a serious runner who wants to do some serious racing.
Dr Colin: Well, maybe it's a good idea to run your findings by someone else who can take an objective third-party look at you. And so some people think, ‘Oh, my foot is so flat, I need to get into this kind of footwear'. And that might not always be the case when it comes down to it. So the footwear component of it is so big. Making sure that it actually fits the way that your foot is designed. So if you have a particularly wide forefoot and a narrower rear foot, looking for things that actually match up with that, so that you're not cramming your toes into a pair of shoes.
Lisa: As a run coach, if I can just pipe in there that has been one of the biggest mistakes that I've seen so many athletes buy. They go into a shoe shop that does foot analysis, and they proceed them on a treadmill and so on. So they may have the right type of shoe, but they're after buying the shoe in a cold state. So i.e., they've just walked into a shop, they haven't been on their feet all day, they haven't been running for 30K's, their feet are not swollen.
And then they go and if they do marathons, or especially ultramarathons, their feet are swelling. And especially I've seen this in women where we tend to swell tissues in my opinion, not scientifically-backed or anything but my observation is that women's feet swell more than men. And the size of the shoe is then way too small, especially in the toe box. And this often leads to pain on the top of the foot and the cutting off of circulation there. And I've seen problems with the shins and so on.
Have you—is it a thing? Have you seen this sort of a trend as well, where they're going into the shop, and it's fitting in the shop on the day that they buy it, but when they're long-distance runners, that becomes a problem, especially when they're running under heat?
Dr Colin: 100%. Yes, I mean, fatigue is one of those things that wrecks everything. But at the end of the day, when you're not fatigued, and you're ready to take a pair of shoes, and you're trying it on, you don't know how the inside of your ankle is gonna rub against that shoe until you've spent 30, 40, 50k in it to really understand what's happening there. So the idea that something is going to ‘break in’, in quotation marks is something that I like to try to shy away from as much as I possibly can.
The biggest issue that we see from most people is they just fit them incorrectly, right? They fit them too short. And so if things do swell, if there's movement or any of that stuff, you're going to get problems along with the feet, whether it's friction and blisters or black toenails, or what have you. The length of that, and then especially the curve of the toes, makes such a big difference.
And so, a lot of footwear stores these days might not carry the full breadth of width available. And so for instance, New Balance comes in ladies from a 2A to a 2E and everything else in between.
Dr Colin: So it comes in a 2A, and a B, and a D and then a 2E. So when you have to carry four widths of shoes from a size 5 to a size 13...
Lisa: That’s expensive.
Dr Colin: ...including half sizes, that's expensive. And that's only for one colour.
Dr Colin: Right? So when you think about that, you understand why you might not be able to find the full breadth of width in a lot of these things. Because shoe stores will have a hard time selling through and if they can't, they can't make money and stay open. So, but if you're one of those people that are on either end of the spectrum, then you need to find a place that will cater towards those kinds of things and that understand the nuances and the differences within brands. So, I mean I've seen people go up a full size in between different models of shoes within the same brand of a company.
Dr Colin: So, for instance, the New Balance 880 and the New Balance 840 fit completely different. The sock liner is three times as thick, the width is more, the toe spring is different, the heel drop is different, all of that stuff. And if you don't know how each one of those things interact with someone, then the potential for injury is just greater.
Lisa: Wow. And yes, I can definitely relate to that having had—I've had many different sponsorship agreements over my career. And some of the companies, a couple of them, I had to actually leave because I just could not wear their shoes and they were so different in other ones that I just absolutely loved and were able to stick with. And I've got a very wide foot. And so I have to be in a men’s shoe. But when I was doing desert races in extreme heat in Death Valley and the likes, I had shoes that were two sizes too big for me.
Dr Colin: Wow.
Lisa: So, that's what I worked out was the sweet spot. So at that point, I wouldn't get the blisters and I wouldn't get the black toenails, and I wouldn't get the foot just swelling so much that it's boosting out the sides of the shoes and putting pressure on top of the foot and causing—and I've had it all awful shin problems by having that circulation cut off at the top of the foot.
I remember a race I did in Germany 338 kilometres in five days. So, we're doing 70 kilometres a day. And after day one, my shoes were just way too tight. And by then the damage was done. And an old-timer, who was in the race, said to me, ‘Hey, you need to cut your socks and open your shoes right up'. And that was a piece of advice that I carried with me being from the norm because, and I ended up doing that very often. So even something like a pair of socks that is too tight around the ankle can cause shin problems. I mean, I've experienced that firsthand, and on the top of the funnel as well. So it really makes a heck of a difference, isn't it?
Dr Colin: Oh, it's so does and you know, when you're looking at the trail shoes and things like that, the choices become even more frustrating.
Lisa: Yes, yes, yes. Yes, let’s talk trail because what trail—we weren't as humans, like, we didn't evolve to run on concrete and pads. So what's your take on how bad is it to be running on roads and concrete versus the natural terrain of a trail so to speak?
Dr Colin: Well, I mean, certainly the natural trait of a trail is going to be easier for you to run on versus concrete and asphalts and those types of things. And when we looked at the literature, and some of the research said that it's—there's been a lot of fun running research that's come out in the last 15 years. But a lot of our initial contact strategies, so whether you stride on your heel, your midfoot or your forefoot, a lot of it has to do with mitigating the force of that initial contact. And so if you're running on an incredibly hard surface, you might adapt to changing your initial contact to be able to mitigate those loads of that initial load.
Whereas when you have a softer, spongier service to do on, you have a bit more leeway to be able to stride in a different pattern. And so for people who are rehabbing from injuries, yes, getting into something that's a little bit spongier is certainly going to be more forgiving. Now, you can take that all the way to running on the beach, and that causing some problems as well just from the increased biomechanics that that causes too. So to get back to my point where moderation.
Dr Colin: There's a time to spend time in the sand, and there's a time to spend time in the trail, and there's time to get on the road.
Lisa: And this trend it transition times, like when the barefoot craze hurt when my friend Chris McDougall’s book came out Born to Run and it sort of revolutionised everybody's thinking was like, ‘We gotta go barefoot because Barefoot Ted was doing it’. And we saw a lot of injuries come out of that. And no, no, no detriment on the book. It was a fantastic book. But people just went too fast, too far too fast. And we really need a transition time if we wanting to go barefoot. Would you agree with that?
Dr Colin: Oh, it's not a matter of me agreeing with it, that that's just a matter of scientific fact.
Dr Colin: I mean, if you want to go from—which so I do agree with it. To that end, yes. There's nothing that's going to increase your risk of getting hurt more than taking off your footwear and going for a barefoot run. If you're used to wearing a maximalist style of shoe, taking it off going barefoot for 21K, you'll be lucky if you don't come back with a stress fracture. And certainly, my practice has been a mirror of that, right? I mean, at the end of the day, I see injured runners all day every day. That's what I do.
So, I like to joke that the greatest predictor of running injuries is running. But to that end, if you want to make these changes, I think they're great for people. And I think that they're able to make these changes in a proper informed way. And so even looking to what some of the scientific literature says they talk about a transition shoe specifically, right? If you're going to go from a regular 10 or 12 mil heel drop shoe to 4, 0, having a 6 to 8 mil transition shoe wouldn't be a bad idea.
There's one company that will remain nameless that when they changed all their heel heights from 12 mil to 8 mil, and no one really understood what that meant. I can't tell you the number of Achilles problems and things that came into the clinic two years after that.
Dr Colin: Because making even that 4-millimetre change in someone who puts in 60 to 80 kilometres a week, and they're used to loading their tissues in a particular way when you all of a sudden change that with up to three times your bodyweight up to 10,000 steps, that's a huge change for your body all of a sudden.
Lisa: Wow, that is insane. Just from a very small change. And look we all—lots of people just swap different shoes ‘Oh try those ones, or this time, I'll buy those’.
Dr Colin: Yes, exactly.
Lisa: And so is it—and this is the other thing, brands keep changing.
Dr Colin: Yes, every season.
Lisa: ‘Ugh, damn. It's something new, it was perfect. And now it's gone again, I can't get it’.
Dr Colin: Yes.
Lisa: So by a couple of pieces, when you do get something that's right.
Dr Colin: 100%. But even that, don't let them sit on the shelves for more than two years.
Lisa: Oh, okay. Why is it? Do they degrade after that you sort of leave them?
Dr Colin: Actually the materials get stiff, the longer you leave them there. And so, that pair that felt really cushy a couple years ago, they let them sit for a couple of years, they're going to be harder...
Lisa: Oh, gosh.
Dr Colin: ...when you take them out of the box.
Lisa: Oh, okay.
Dr Colin: So you can't just let them sit for years on the shelf.
Lisa: And onto that note. How many kilometres? Like, how often should you be changing? I've always said between six and 800 kilometres max, what's your take on that? Is there a new science around that?
Dr Colin: Science is interesting when it comes to that. I mean, there isn't a lot of actual hard science on that. The soft science of it is to look at the bottoms of your shoes and see. If you're a heavier person, at your initial contact, and I don't mean heavy, like actually just a larger BMI. But some people, my wife is a light woman but she sounds like she's going to come through the floor, two floors down when she walks. And so she'll wear out the outsole of a shoe much faster than somebody who strikes the ground a little bit lighter. And so if you look at the bottoms of your footwear and let's say you're only 400K into a pair of shoes, but there's an angle now where the lugs are totally sheared off one side, that shoe was now forcing you to walk that way. And it's not helping your biomechanics at all.
And so yes, I think as it—as a general rule, 6 to 800 kilometres is okay. But if you're not, if you're training on consecutive days, and if you're training in one pair of shoes, you're going to break down the EVA material much faster because that material needs about 36 hours to rebound fully, before it's ready to go again. But if you're training 24 hours, you're going to break down your shoe much faster.
Lisa: Wow, that's a good point. I knew that. And I'd forgotten that fact. Thanks for reminding me of that because yes, alternating shoes on different days is something that I used to say, and I’ve forgotten completely about that one. So, that's a really good point. So, having a couple of pairs of shoes on the go, is a really, really good idea.
Dr Colin: Yes, 100%. And to that end too we were talking about, with transition shoes, and whatnot, having them even a different heel heights for different types of running would also be great. I mean, so while you're doing a fartlek training, or tempo run, or a long day might be different than what your ratio is, or the all day everyday shoe. And so that little bit of variability, I think, is a really positive thing.
When you get locked into one movement pattern all the time, then your body comes to predict that. And if you can get that little bit of variability where you're lengthening some days, you're shortening some days, you're doing different things, and your body is used to that, then you're going to be more adaptive. But if you lock into that one pattern, it's going to be so much harder to change.
Lisa: That seems to be the thing for everything in biology column. It seems to be a push and pull in a variety. You don't want to starve for too long, you don't want to eat too much for too long, you don't want to be too cold or in a thermoneutral zone for too long, you want—the body wants variety change. Not the same diet every day, not the same everything every day, and just by varying things up, we're giving our body a chance to get what it needs, and to have that variation—that push and pull that biology in all levels that I've been looking at seems to be cycling things. Cycling diet, cycling supplements, cycling shoes, cycling, changing in variety keeps the body guessing and keeps it changing, and keeps it so it doesn't go, ‘I've got this. And it's a piece of cake'.
Actually, I thought it just popped in my head. What do you think of Kipchoge shoes? The sub-two-hour marathon, the Nike shoes.
Dr Colin: Oh, yes. Yes, I mean, wow, there—this is a fun time to be alive for nerds like myself. So yes, I mean, there's some really cool stuff that Nike’s doing in some of their footwear. And they're—I mean, one of the leaders. But I mean, everyone now is coming out with a carbon plated shoe, and really aggressive rockers, and a lot of this stuff from a performance standpoint. And it'll be interesting to see how it's controlled and how it's covered. And to what lengths can we go to be able to increase the performance of humans? We developed things like oxygen deprivation to be able to increase your red blood cell counts, to be able to increase your performance. Changes in footwear like this are not that dissimilar from that. It's just a question of, how much can we use them? And how does it work with you?
Dr Colin: Yes, and what's gonna be legal.
Lisa: And at the moment, it is, isn't it? Like it's...
Dr Colin: It is.
Lisa: Yes. And I had a friend, who's a holistic movement coach, I had on the show, actually, a few weeks ago talking about feet as well, the health of feet. And he said, ‘I didn't want to like those Kipchoge shoes', but I— because he's very much into barefoot when possible and developing strength in the feet. He said, ‘But I put’...
Dr Colin: Well, that certainly is the opposite.
Lisa: He said, ‘I have to admit, I run a hell of a lot faster when I'm soaked’.
Dr Colin: Sure. Yes. But that comes back to the point of moderation, right? Is that there's a time for that shoe, just like there's a time to be barefoot. And it's using it in the appropriate fashion.
Lisa: Wow, that's brilliant. And okay, let's talk about the knock-on effect of how the feet which have and you know this 100 times better than me, there's just a ton of nerves, a ton of bones as most complex structure that we have, the proprioception, and the connection between the brain is just so important that we actually have that neurofeedback from our feet. So, what sort of a fix do—what sort of things can we expect to have happen on a good side from proprioception when we're doing lots of activity? And we're doing lots of different movement types and varieties of training? And how does it help our brain? The brain-foot connection, I think, is what I'm trying to ask you here.
Dr Colin: Well, I mean, anything that's going to make you more aware of what your foot’s doing in space is, again, only going to be a positive both from a balance and a performance perspective. It's striking to me that I can see some people perform incredible feats of athleticism, but then can't balance on one foot to do a pistol squat.
Dr Colin: Do you know what I mean?
Dr Colin: Because they just don't have control over their ankle. And so when people think of their feet, that's one thing. But I mean, the actual foot itself, though, those deep intrinsic layers of muscles are more stabilisers than they are prime movers, right? The prime movers are going to be higher up in the leg, and the tendons of those larger muscles in the leg support the ankle, right? They're the ones that are tibialis posterior, and the perennials and the things that actually wrap around the ankle. So it's a matter of looking at the lower leg holistically, not just the foot itself.
Yes, those little foot muscles are important. But I think oftentimes, some of the higher stuff up is overlooked as well as the actual prime movers and the actual real good stabilizers that way because those things are going to fatigue out relatively fast, and then you're left with the larger muscles to be able to do some of those things. But when you're not paying attention to one of those two, then you're going to get a mismatch in balance and performance. And so it's a matter of being able to look at more. It's about being able to use your abductor hallucis appropriately, being able to use all of those intrinsics to raise up your arch a bit and reduce some strain in your plantar fascia.
I would never go as far as saying you're going to change the structure of your foot by making your foot muscles strong, but certainly, you're going to get a better grip on the ground and you're going to be able to use your feet like feet and not just like a meat slab that hit the ground to be able to get to the next step.
Lisa: Yes, is it a bit like if I was to go around with gloves all day, and I wouldn't have the dexterity that I would need to do typing and learn to play an instrument or anything like that. Is that what's happening with our shoes, when we’re in shoes all day, every day, we're just taking away that connection to the brain and the brain's ability to be able to make those subtle adjustments with those little tiny muscles doing their thing?
Dr Colin: You can look at it two different ways, right? Because one might say that yes, if you're barefoot and you know you've got skin on the ground, you are going to get a different sensation than if you have sock and then something else between you and the ground. Right? There's just different feedback when it comes to it.
But to say that putting footwear on reduces your proprioception, or your sensation completely, is a bit of a misnomer. Because if you have something that's, let's say, a little bit squishier, and your foot’s moving around a bit more, well, that's also a signal to your brain too in terms of where to fire muscles, and how to fire muscles and using those muscles on top of it. So, I think we can go in both directions. And again, there is a time when it's going to be appropriate. And there's a time when you want to be barefoot and getting that sensory input in just a different fashion to say—because, at the end of the day, I just don't think it's realistic in the society that we live in that we're not going to be out of it completely.
Lisa: We don’t want to come from class, and you know...
Dr Colin: And so yes. So it's a matter of figuring out how to do that, in a fashion that's most appropriate, given the circumstances that you find yourself in.
Lisa: A bit of a left-field question and a bit of a non-scientific well, oh well, there's probably stuff coming out now. What's your take on having though the connection to Mother Earth and grounding? And that type of thing, and being in the dirt, so to speak, and having the actual contact with the earth? Is there anything to that side of things? Or is it just no scientific data really around that?
Dr Colin: There's absolutely nothing wrong with that, at the end of the day, and from a data and a science standpoint, I'm the first one to tell you that I'm not 100% up on that.
Dr Colin: But I was listening to another podcast. It was Ben Greenfield recently.
Lisa: Yes, I like him.
Dr Colin: Who was talking about some of—yes, yes, yes, same—as some of the science around that specifically. And I believe that there might be some science that has come out, I just haven't read it to be able to be up on it to be 100% honest with you.
Lisa: Yes. I mean, I've heard various things and even like getting your hands on the dirt and gardening and how much of a good effect that can have on your body and your mind and your mood and things like that.
Dr Colin: Yes.
Lisa: And I mean, we are in science starting to actually see why is it important to go out and have early morning sunlight and circadian rhythms and all of these sorts of things...
Dr Colin: True, true.
Lisa: ...and connection to the ground and the effects of the medicine, and I don't think we're there yet with all the science. But my take is—on that is yes, go out and spend 10 minutes a day with your hands and the dirt and connect with the ground. And if nothing, the being in nature is definitely going to calm you down and make you feel better.
Dr Colin: 100%.
Lisa: Yes, so that's already, I think—okay, so just looking at some most common running injuries before we sort of wrap up the call. If we can look at like plantar fasciitis and perhaps Achilles and calf muscle injuries and perhaps knees. It's a picture you will cover in a few minutes, isn't it? If we want, the second podcast, Dr Colin.
Dr Colin: Yes. We can do a podcast on each one of those actually.
Lisa: Well, actually, I think I will be getting you on because your knowledge is next level.
Dr Colin: Thank you.
Lisa: So let's talk a little bit about say Achilles.
Dr Colin: Sure.
Lisa: It's one of—it's a very common problem.
Dr Colin: It is. Yes, yes, it really, really is. And Achilles is a difficult one. Again, depending on where things are at and what we know, whether it's insertional, or midportion, there are definitely are two different protocols when it comes to it. So, from the physio side whether you do eccentric loading, which is raising up on two feet, lowering down on one or whether you're doing a different kind of strengthening programme that really is sort of the physio side of that end of it, where I tend to come in on that and where I tend to see a lot of Achilles injuries are people who wind up changing the drop of their shoe too quickly. And so they're used to running in something that's either too low or too high and then make it an abrupt sudden change, or they change their running style too quickly.
So, it's very common to see people who go—who are heel strikers who want to try forefoot running for the first time and if they do it improperly when you load the ground with your heel, I mean, yes, we know that if you overstride braking forces and everything else are really bad for you and smashing your heel into the ground might not be ideal for everybody.
But if you're running on your forefoot, you're striking, your initial contact is with your forefoot, then you touch your heel. Then you push off your forefoot again, right? So, one is heel midfoot toe, one is forefoot heel, forefoot. So, to that end, you're going through a much larger cycle of Achilles loading. And so for some people, especially who—if gene, you were talking about genetics earlier, we know that there is a genetic predisposition for some people, or Achilles issues specifically if you're one of those people, then that can certainly be a bad thing if you do it too quickly.
And so to that end, we talked about the very first thing we do is deload the Achilles. So using things like heel shoe, heel lifts, and footwear, to be able to, for a short period of time, take some of that load off the Achilles, allow it to heal and then gradually reloaded it as they've been working with their physio to be able to gain back strength and mobility and everything else. The one thing that I like to look at everybody who comes to my clinic because I think it's so incredibly important, is their ability to move their ankle appropriately because their calf musculature is flexible enough.
Dr Colin: And I'll get into trouble there because some people say, ‘It's not coming from your calf, it's coming from your hip'. It can be coming from your hip certainly if you have things that are changing your pelvic tilt, and it's lengthening your hamstring, and it's doing that, and then you're getting the effect of change that comes with it, it's a matter of just looking at it to understand where that change is coming from. But any ankle restriction in your range of motion can make you use your Achilles in a different way, the simplest way for your body to compensate for that is to out-toe and pronate more, well, you're going to get a rotational stress on your Achilles, for some people that's just going to be too much combined with the kind of running programme that they're doing. And so one thing to think about for sure.
Lisa: Wow, this is like, you're a foot specialist, but you also need to have a really good understanding of the whole anatomy of the body really, don't you? Because you have to be a holistic in your approach because, and then this is one of the issues that I have with the medical world in general, now speaking is that they’re so siloed. If you've got a lung problem, you go to the lung specialist, or the pulmonary, if you've got a heart and then the ear, nose and throat are separate, and yet it's to do with your lungs, like, we need to have a holistic ‘Look At It systems’ in the body or the—not even systems, but the entire body, so everybody has to have it.
Dr Colin: Yes.
Lisa: And it's difficult because you have to have a specialised education in feet, you can't be an expert in feet and an expert in hips.
Dr Colin: Yes.
Lisa: But you do need a general education to be able to understand: what the roles of the other therapists or doctors or whatever it is in order to have a good understanding. And I think that holistic approach were possible, into sort of disciplinary communication, is really, really important. Would you agree with it?
Dr Colin: Oh, that's the only way that I work is multi-disciplinary. And so if there's one specialist that thinks that they can fix everything, then that usually makes me want to run away screaming. And because there's just isn't enough flexibility in your thinking to understand that, maybe what you're doing won't be enough for somebody. And again, can't tell you the number of people that come in to say, ‘I've seen my ex-specialists who said, there's nothing else that can be done. We get them back running within six weeks'.
Dr Colin: You know what I mean? It's only because we were flexible enough in our thinking to be able to say, ‘Yes, we're gonna change this little thing over here. That might be the thing that's going to get you back to what you want to be doing'. So, it’s so...
Lisa: I could go in a rant on that, really. I could go on a rant about the amount of times that people have been told, ‘You can never run again'. I was told I would never run when I broke my back when I was a young lady. And that were wrong, 70,000 kilometres later.
Dr Colin: Yes.
Lisa: If I'd lifted up to so-called experts who, with my mother who had a massive brain aneurysm five years ago and who said that initial, ‘You’ll never have any quality of life again’. She's got massive brain damage. They were wrong. I spent five years rehabilitating her, but they were wrong, and she's completely normal again. So, it's not just accepting—what I think is important to realise is the limitations of your knowledge and saying, ‘Hey, I don't know, I'm at the end of my abilities'. You might have to look somewhere else, or outside the square, or try something else to talk, to so and so.
Dr Colin: Yes.
Lisa: And that's fine. That's good if we get there but not blanket saying, ‘Well, you can never run again because you've got a knee injury.’ The amount of times, amount of runners who have come on doctors said I should never run again because I've got some slight knee problems, and I was like, ‘Really?’
Dr Colin: Yes, no, I agree. So, a case in point in my own life, I have congenital arthritis. That's so bad. I had my first hip reconstruction at 17.
Dr Colin: That left me with a four-centimetre leg length discrepancy. So I've got some real orthopaedic problems. And was racing mountain bikes at almost the pro-level in Canada in downhill at the time, and wanted to pursue that. And I was told, ‘Never ride a bike again', this kind of stuff. And I'll be doing a half Ironman in Muskoka in July...
Lisa: Wow. I love it.
Dr Colin: ...25 years later.
Dr Colin: So, yes. At the end of the day...
Lisa: And if we keep founding way round the problem. Yes.
Dr Colin: Yes, I mean, you know your limits better than somebody else. But I think that there's also a time when you do need to respect the knowledge that someone's done and spent time attaining. But if they'll put aside all of your own expectations and things, then they're not doing you a good service.
Lisa: No, no. And sometimes they're wrong, and they're just not up—what I'm also saying, and we're getting off on a tangent here, but it is a—if your life is different there's definitely a 20-year lag between what's actually the latest in science and what's actually happening in clinical practice.
Dr Colin: Yes, true.
Lisa: And not so much in the area like you have, but saying things like critical care and things like this, it's just so far behind the eight ball because there's so many hoops that they have to jump through in order to get anything changed, that the science can be saying, ‘Hey, this is what you need to be doing'. And they'll be like, ‘Yes, we need another 20 years before we got adopted'.
Dr Colin: Yes, knowledge translation is difficult.
Lisa: Yes, it just seems to be this huge lag, and in some areas of medicine but I've gotten completely off-topic. But I love talking with people that are on the cutting edge of stuff, and I find your knowledge is absolutely next level.
Colin, I think we're gonna have to get you back because we didn't even get to plantar fasciitis and hips and knees, and all the rest of it and...
Dr Colin: I'd love to.
Lisa: Yes, what you're doing... So, before we wrap it up, where can people find out your books and obviously, you've said on Amazon, but give us your websites, and where people can follow you on Instagram and all that sort of good stuff.
Dr Colin: So we're just starting to build out a website called stuffaboutfeet.com. So that's probably the best place to get me right now. You'll be able to see some of the books that are on there, other podcasts that I've done, you'll watch some videos, and then that's going to be built up just more and more and moreover the coming weeks and months.
And through that site, you'll be able to get to me whether it's a personal email or you want to get on the socials or what have you. And so I've been kind of locked away in both the research lab and the clinic office for too many years. And now we're going to get me a bit more online and doing a few more of these things.
Lisa: Yes, and you're so talented at this interviewing and stuff. So it's really easy to be able to share your knowledge and to get it out there. And then you can have much more of a massive impact worldwide rather than just locally, which is fantastic. You know that we can do that now with technology. So I love getting world-leading people on the show and sharing the amazing insights. And you definitely right up there, Colin. So thank you very, very much for sharing your insights today. So stuffaboutfeet.com, was that right? Was that correct? And that you've been listening to Colin Dombrowski.
Colin, any last words that you would like to share with people out there?