Toning shoes are considered to be shoes that are deliberately made unstable with design features like a rocker bottom shoe. The purpose of this instability is to create a balance problem so that the muscles have to work harder to compensate. As a result it is claimed that this gives an extra workout or ‘tone up’ when wearing the shoes. That is how the name ‘toning’ was applied to this class of exercise footwear. The sector of the market was originally made popular by the MBT (Masai Barefoot Technology) shoes and then later by the Skechers Shape Ups and The Reebok Easy Tone shoes.

What characterized the toning shoes sector initially were the extremely exaggerated and over-hyped claims that were made for the benefits of those muscles working harder due to the design of the shoes. There were advertisements that the shoes could give you a better ‘butt’ as a result of the tone up. There were claims that the extra work could help you lose more weight when you exercise and there were even claims that these shoes could help contribute to a solution to the global obesity epidemic if everyone started using them! There were claims about how they could improve the circulation and varicose veins. Endorsements by several celebrities also helped hype up the benefit of these shoes.

Eventually the Federal Trade Commission (FTC) and the American Council of Fitness (ACE) took a closer look at the claims. Firstly the ACE sponsored a study to test the claims and they found none of them to be true. They found there was no increased muscle activity while wearing the shoes and also no increased expenditure of calories when wearing them compared to a conventional training shoe. Other studies have found minor changes in muscle activity while some others have not found any differences. So effectively, the evidence did not support what the marketing hype was claiming. Both Skechers and Reebok were taken to task by the FTC for the claims and both companies agrees to settle for multi-million dollar amounts.

It is not clear exactly where the toning shoe sector will head now. The shoes do possibly have some uses in some clinical conditions. For example a number of clinicians are using them for thing like painful hallux rigidus. Others are trialling them in people with chronic postural problems due to the slight change that they induce in the gait. Some athlete may also benefit from them with periodic use in order to use the lower limb muscles in a different way for short periods of time.

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But the type of sport played and gender did, according to a new study published in BioMed Central’s open access journal Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology. This study into varsity athletics found that women had a shorter time to injury than men and that certain sports, such as volleyball, also had a significantly shorter time to injury than others, such as hockey or basketball.

Fitness evaluation and pre-participation are standard practice in university sport. They screen the athletes for health problems and for high-risk behaviors which may affect performance throughout the season. Researchers from the Faculty of Physical Education and Recreation and the Faculty of Rehabilitation Medicine at the University of Alberta, measured pre-season fitness for six varsity teams.

They used a vertical jump test to estimate instantaneous anaerobic power and lower body strength and a sit and reach test to evaluate lower back and hip flexibility. Another test measured agility (acceleration, deceleration, pivoting and quick footwork). Push-ups were used to measure upper body endurance, and sit-ups determined core strength and flexibility. Shoulder flexibility was also assessed. Both practice and game time were recorded to give to time to injury.

Over two thirds of the sports players in the study suffered injury throughout the season, most commonly muscle or tendon strain in the legs or feet. Although players missed practice time due to their injuries (55% missed at least one practice due to injury) most did not miss any games. In fact about 40% of injuries occurred during preseason practice.

Time to first injury was shorter for the women than the men occurring on average 40% of the way through the season for female athletes, and 66% of the way through the season for males. Time to injury also depended on sport with the injuries occurring sooner in volleyball than any other sport tested. For women, volleyball injury occurred, on average, less than 20% of the way through the season, and 35% for men. Men’s hockey was the safest sport with first injuries only occurring, on average, three quarters of the way through the season.

Analysis of the fitness evaluation showed that time to injury was not affected by the level of pre-season fitness. Michael Kennedy, one of the team who performed this study explained, “The only association we found between preseason fitness and injury was that lower upper body strength, as evaluated by push-ups, was associated with a shorter time to injury – this was despite most of the injuries being associated with the lower body.”

Prof Kennedy continued, “Our study attempted to answer the question whether fitter athletes are more resilient to injury than less fit athletes. We know from our data that differences exist between risk of injury in pre-season training, regular season training and actual games. However most importantly our data clearly show that time to first injury for athletes is more heavily influenced by gender and sport than pre-season fitness.”

This article is part of the Advances in Sports Nutrition, Exercise and Medicine cross-journal thematic series, which includes articles offering novel insights and clinical significance in all aspects of sports medicine.

Link to article

Chi running is one of the many different running forms that are being promoted as a means to run better, feel better about running and get fewer injuries. Chi running as a concept was first promoted by Danny Dreyer who developed it as part of his ultramarathon training program. As a technique it advocates a more forward lean of the torso and more of a heel strike as opposed to a heal strike. Most of the support for Chi running is based on testimonials and there is no research that supports it as being any better than any other running technique.

I have been seeing more posterior tibial tendonitis lately. If I did not know any better, I would say it was getting more common. This would be consistent with the increased interest in barefoot or minimalist running. This running technique which is a forefoot strike compared to a rearfoot strike makes the posterior tibial muscle work harder, so no wonder that posterior tibial tendonitis is becoming more common with the trend to these types of running techniques (which also include the Chi ad Pose forms). The symptoms of posterior tibial tendonitis are generally felt just above and/or just below the medial malleolus and sometimes down into the arch of the foot. The treatment or posterior tibial tendonitis is to reduce the workload of the posterior tibial muscle. This usually means foot orthotics and reverting to heel or rearfoot striking. The rearfoot striking may only need to be temporary and a transition can be made back to the forefoot after the problem as resolved.

The plantar plate is an important structure of the first metatarsophalangeal joints in the foot. The plantar plate is part of the plantar fascia and is a thickening of the plantar aspect of the joint capsule. Plantar plate dysfunction is a common cause of pain under the first metatarsophalangeal joint. Ultrasound often demonstrates a plantar plate tear that may need surgical repair. The treatment of a plantar plate dysfunction is initially to use something like a metatarsal pad or strapping to plantarflex the toe to allow it to heal. Often a metatarsal pad may need to be used long term.

Sesamoiditis is a common problem in athlete with high loads under the first metatarsophalangeal joint. It is not really a sesamoiditis, as it is an inflammation of the soft tissues around the sesamoid bones at this joint. The pain of sesamoiditis is usually on direct palpation of the area. Imaging is sometimes useful to rule out a fracture of the sesamoid bone. The reason for the higher loads is due to the structure of the foot, most common a higher arched foot with a plantarflexed first ray which when combined with higher levels of activity can create this problem. Sesamoiditis can also be more common in sports that involve pivoting on the first metatarsophalangeal joint such as tennis. The initial treatment if sesamoidtis is the use to offloading techniques in foot orthoses to reduce the load on this structure. Sometimes adding an anti-shear cover to the foot orthoses will help with the pivoting motions. If conservative measures are not successful, then surgical management such as elevating the first metatarsal or the more drastic measure of removing the sesamoid have been tried for sesamoiditis.

This is a common problem in athletes. Sinus tarsi syndrome generally occurs in two situations that are almost opposite to each other. One is that the structures in the sinus tarsi can be damaged during an inversion ankle sprain. Often this problem goes undetected until some of the original ankle sprain settles. The other condition is an excessively flat or pronated foot that pushes the subtalar joint to its end range of motion and compresses the tissues in the sinus tarsi. In both cases there can be a feeling of instability and pain is generally palpated over the sinus tarsi on the lateral side of the ankle joint.

Treatment is mostly done with physical therapy in both situations. Foot orthotics are generally needed if the causes is a flat pronated foot. Occasionally a series of steroid injections into the sinus tarsi will be helpful.

For the latest on sinus tarsi syndrome, see Podiatry Arena:
What actually hurts in sinus tarsi syndrome
Foot orthotics for sinus tarsi syndrome

Exercise for those with diabetes is extremely important. It is important for general health and fitness as well as weight control. There are also some diabetes specific benefits of exercise for those with diabetes such as assisting in glucose controls and also in type two diabetes its also has the affect of increasing insulin sensitivity. Those with diabetes who exercise need to take precautions such as the timing and amounts of insulin injections relative to the timing of exercise. There is one other problem that those exercising need to be conscious of and that is the ‘diabetic foot’. The foot is at increased risk for damage because of the diabetes and that damage may not be detected. Stress fractures are more common in those with diabetes and in the worse case; a Charcot foot problem may develop. Those with diabetes and sign of peripheral neuropathy are at greater risk for diabetic foot problems and are probably better off avoiding weight bearing exercise and take part in activities like cycling and swimming.

The April 2010 edition of  Podiatry Today magazine has a good update of the latest concepts in Medial Tibial Stress Syndrome by Kevin Kirby. Two interesting key concepts that came through in the review is that there is no agreement on exactly what is the pathological process in the condition – is it a soft tissue traction issue or a bone stress reaction due to tibial bending actions?  The tibial bending moments are a recent consideration in the risk factors for this condition. If medial tibial stress syndrome is due to tibial bending moments, then this has implications for the use and prescription of foot orthotics and running shoes to alter these bending moments. There has been some discussion on this concept for medial tibial stress syndrome.

In a recent edition of Radiological Medicine there is a new study that investigated the use of a weightbearing MRI to assess those with plantar fasciitis. They were able to report that the changes in the MRI signal that was associated with plantar fasciitis when compared by blinded examiners in those without plantar fasciitis. Unlike the usual ultrasound finding, the thickness of the plantar fascia was reduced due to stretching in the weightbearing position compared to the supine position. This is an importantt observation given the emphasis  that gets put on the thickness of the plantar fascia with ultrasound measurement which is done non-weightbearing. The important finding in this study was of 15 cases that they looked at, 4 had partial tears of the plantar fascia visible on the weightbearing MRI. This has implications for sports medicine as a number of the cases of plantar fasciitis that are seen, may infact be partial tears.