Am I wearing the right shoe?

There is one question that is paramount in every runners mind who are experiencing symptoms:  Am I wearing the right shoe?  Recent studies, however, are beginning to reveal that this may not be the best question to ask.  Perhaps a better question might be, Am I wearing the wrong shoe? And also, Why am I having symptoms?

Shoe shoppers are often swayed by a sales person with fancy terms like stability shoe, neutral shoe or motion control shoe.  Retailers will prescribe a shoe that fits one of these categories based on a quick and dirty FPI (Foot Posture Index) test, which has a reliability rate of > 80%.  The FPI can quickly and easily determine if someone has excessive pronation to excessive supination, allowing the salesman to prescribe the shoe they think is best for their customer.

Up until this point, different styles of running shoes have been prescribed based on an individual’s need for support. The greater the likelihood of pronation, the greater amount of support would be recommended in the shoe. This logic stems from the belief that pronation is the root cause of foot pain for every runner.  Runners who required maximum support due to excessive pronation would be given a “motion control” type shoe.  Those who required good support would be prescribed a “stability” shoe.  Then there are those who didn’t need support, but needed “middle of the road” support. These would be prescribed a “cushioned/neutral” type shoe. Lastly, current running trends have led to the thinking that those who required little to no support would be given a “minimalist” shoe.

However, recent studies have started to question the idea that foot pain in runners may not be controlled by a specific shoe type.

In one study, for example, 81 female runners between the ages of 18 and 50 were evaluated using the FPI and categorized into 3 foot types: neutral, pronated and highly pronated. Despite their foot type, the participants were then randomly assigned either a neutral shoe, a stability shoe, or a motion control shoe. The participants then underwent 13 weeks of marathon training.  The results revealed that there were the most complaints of pain from those who trained in a motion control shoe.  Additionally, those with neutral feet, reported greater values of pain in the neutral shoe. Furthermore, those with pronated feet, reported greater values of pain while running in the stability shoe.  Lastly, highly pronated feet were concluded to need more study. Based on this information is might be clear that there is a wrong shoe and, that shoe type and foot type don’t always correlate.

Another study tested pronated foot types by implementing training regimens that used motion control shoes, neutral shoes and stability shoes.  So, basically, the same individuals were tested doing the same exercises with different shoe types on. Results revealed the most pain occurred when the participants wore the motion control shoes, less pain occurred while wearing stability shoes and the least pain occurred with neutral shoes.  The most alarming finding was that wearing  motion control shoes resulted in the greatest % of lost training days, regardless of foot type.

Other measures for shoe prescription have also included the height of an individual’s arch, which can be determined by reading an imprint or a fancy computerized pressure sensor. An additional study looked at 3000 US Military personnel to examine this concept.  Recruits in the experimental group wore motion-control, stability, or cushioned shoes that matched their plantar shape. These three types of shoes were given to those with a low, medium, or high foot arch, respectively. The control group received a stability shoe regardless of plantar shape. Injuries during basic training were assessed from outpatient medical records.  The conclusion was that selecting running shoes based on arch height had little influence on injury risk in military basic training.

Lastly, another study tracked 927 female runners for 1 year.  They all ran in a neutral shoe, despite the fact that a variety of foot types that ranged from highly supinated to highly pronated, were measured and recorded. The study concluded that based on the results, foot pronation was not associated with increased injury risk or pain while wearing a neutral shoe.  Motion control shoes led to increased complaints in both the highly pronated group, as well as, the highly supinated group.  Those who had highly supinated feet had the least complaints in a neutral shoe.

Based on these findings, it is apparent there really does not seem to be a “right” shoe for each runner.  The data reveals that comfort should reign supreme in shoe prescription and selection.  When we look at research that uses the FPI to measure multiple shoe types against the foot types, there is no statistical difference in regards to injury and pain. In conclusion, these results reveal the question that runners should be asking: is there a wrong shoe for me?  Some shoes will make your pain worse, but there is no guarantee that there is one out there that will keep it from happening.

As a Physical Therapist and a runner, I would submit that rather than examining foot type and shoe-wear so closely, runners should receive an Optogait evaluation. This state of the art technology can immediately identify asymmetries further up the chain in the hips and core. By using LED lights to sense inconsistencies in a person’s stride, the Optogait measures reactive forces of impact in the feet and ankles. This data can then be used to determine foot pain that is a result of deficits in strength and stability in the hips and core. Correct intervention can be determined and results achieved with this information.

Burger Rehab can perform this evaluation and prescribe the correction program for you to set you on a path of training without the risk of injury and pain. Rather than trying different shoe types to eradicate pain in your feet, we suggest determining why you have this pain in the first place.

Schedule an Optogait evaluation with Burger Rehab and get real data, in real time, and find out what is really wrong.

Larry Gray MPT


Winners of the Holiday Card Contest

We would like to announce the winners of the 2011 Holiday Card contest for Burger Rehab.

  • 1rst Place – Burger Physical Therapy Laguna  44.9% of the votes
  • 2nd Place – Burger Rehabilitation Woodland/CHW  33.5% of the votes
  • 3rd Place – Burger Physical Therapy Natomas 14.3% of the votes

Thank you too all of you who voted.  

Holiday Card Contest

Hi Burger Team,

Well the time has come to vote on your favorite Holiday card for the season.  This year we had some really great cards and we will be rewarding the top 3 cards in the new year.  I hope you will all take a minute out of your busy days to vote on these very spirited and festive cards.

Just click on the link below to start the process and remember to only vote for your favorite.  Have fun!

Holiday Card Contest Poll


Have you ever seen the animated film Ratatouille… it’s a clever film about a humans, the restaurant industry and a little Rat. Debbie Basile in our AP department and I occasionally speak about the movie as being one of our favorites. In building up to the finale, there is a scene where the local ‘Critic’ comes to eat a meal and Demands to be impressed. He ASKs for “A little Perspective!” What follows is a great scene where the critic is impressed and ultimately reflects back on his own limitations in asking much of others yet not risking anything of himself in serving others…

I thought about this a bit this week. For some of us, the pressures of getting it “ALL” done right the first time seems so easy to consultants, facility leaders and others who are afforded the time to criticize our work yet doing the work and doing it well and with passion is not always easy. Recently I was speaking to a consultant who was sharing with me some issues she found when visiting another Skilled Nursing Facility in the area… As a consultant she and her team discovered some areas that could be improved.  The message was here is a problem and it needs to be fixed.  As a result there was heightened pressure of the SNF owners, consultants down to direct pressures on the healthcare team… to correct X, Y and Z issues and do it yesterday!

What really caught my attention was during this process, speaking to the consultant it was revealed that other organizations are “much worse than the organization in question, in fact “X” facility has some of the best we’ve seen” yet the message to the facilities, and filtered down to the team was here is a problem and fix it yesterday!

I believe too often we focus our energy on the 2% of issues and forget to appreciate the 98% of the efforts that we do daily to make a positive difference.

What you should know about IASTM

Shawn Burger… 

A growing trend in Physical Therapy is the use of IASTM.  Frankly most people do not understand the value of it.  Let me do my best to explain through a little Q and A.

Q.  What is IASTM?

                A.  IASTM is a form of massage where “instruments” or a “Tool” is used in place of one’s hands.

Q.  Why would I want IASTM?

                A.  Early Research and growing anecdotal evidence leads us to believe patients get better results.

Q.  How does IASTM work?

                A.  Mechanically, early evidence suggests that IASTM works as a stimulant of the inflammatory cascade.  Meaning patients with muscular-skeletal problems involving muscles and soft tissue (i.e. Ligaments, Tendons and fascia) who suffer from chronic pain may have their tissue “stuck” in the healing cascade and unable to heal themselves.  Research shows that Fibroblasts are significantly stimulated with the technique.

Q.  When did IASTM begin?

                A.  Various models of the technique have been around in cultures for thousands of years.  In the Western Healthcare Model, IASTM began in earnest during the early to mid 90’s in Indiana.

Q.  Who and what are the IASTM techniques?

                A.  There are 3 major competitors in the IASTM market all originated from the same research and same principle “partners.”  The original Technique was called Grastech, changing its name to Graston after the founder David Graston.  Later on, Dr. Sevier, one of the principles left to start his own company ASTYM and later still, David Graston having sold Graston Technique started his own company SASTM.

Q.  What difference is there between the 3 major IASTM companies?

                A.  Materials, Education and Business Model.  The technique minus semantic vernacular is the same.

Graston Technique:  Steel Instruments, 25.5 hours of training, clinician purchases for aprox $3700

ASTYM:  Plastic Instruments, 12 hours of training, clinician pays $700/yr for 10 years ($7000 total)

SASTM:  Plastic Instruments, 4-6 hours of training, aprox $1000 investment.


                A.  We offer Graston Technique at all twelve (12) of our sites.  We particularly like that the instruments are made of steel and therefore we feel more comfortably that they can be truly CLEANED between uses from one patient to the other.   Along with their quality clinical education are driving forces in our ability in maintaining a quality work environment.

# 1

Shawn Burger…

Many analogies attempt to explain why we choose things.  “The grass is greener…”  “One man’s trash is another’s…”  “you say potato’, I say…” come to mind. 

This week I was reminded we can’t please everyone when I received a complaint from a client who did not like their Physical Therapist.   I was told that X Company in X location was better.  Maybe true…

But I got to thinking that Physical Therapists are simply people.  Like you and I, like the Doctors that refer us, we are ALL different.  No two of us are alike.  That’s when I took a breath and appreciated how great Burger Physical Therapy is.  We have a team of over 76 licensed clinicians in the 5 county Sacramento region.  Unlike other pastures where you might find one or two clinicians, we have the opportunity to work with people who have extraordinary experience in various fields and subspecialties.   This list is long… we have experts in almost every field!  That is what allows us to continue to be the first choice for area physicians. 

Today it was announced that Burger was once again the #1 Physical Therapy provider in the area.  With the support and trust of UC-Davis, Hills Physicians and many other Physician Groups, we say Thank You!

Something for us to be proud of!

Want or Need?

Shawn Burger…

I pondered our services this week as I tried to determine between a want and a need.  I was given a gift card recently to “Peets Coffee and Tea.”  Without much thought, I discovered myself frequenting Peets not once, but twice a day.  Why not?  Its free right…

Well, it’s not actually free as my gift card quickly dropped to a $.49 balance before I finished the month.

Isn’t this like Health Care???  When we have a low – no co pay why not see the Doctor for every ache, sniffle and cramp…  but when we have to pay for the services, we better be dying before we call for an appointment.    I wonder if everyone paid full Value for their services, how much of those services would be used?  Would we really have a MD, Nurse and Physical Therapy shortage?  

Probably not…

Aide Games

Shawn Burger… Our Roseville Team Leader sent me the following message…

 “I wanted to catch you up on the Aide Games we had at our staff meeting last week.  We narrowed down 10 or so different “events” to four and had our 5 aides compete.  All of the events were related to aide tasks and each one had points attached.  The first competition was the towel fold/pillow prep.  They had 5 towels to fold and 2 pillows to put cases on.  Points were awarded based on order of finish.  The next event was the towel toss.  Each aide had the chance to throw towels into the towel basket and points were given depending on the location of made attempts.  We also had the kinesiotape cut where they raced to cut a piece of tape 6 inches long and round the edges.  Again, points were given based on order of finish.  The final event was the timer diffuser.  This one really separated the men from the boys.  We placed 5 timers throughout the clinic and set them to go off simultaneously.  We timed how long it took the aides to turn them all off and points were given.  I really wish we had video of this…everyone had a blast.  Winning prize (a pack of gum and $25 Visa gift card) but it was a close race.  We had a great time…pretty funny stuff.  Talk to you later! “

I wanted to thank our Roseville Team!  Often, we miss opportunities in life that are right in front of us.  We look for someone to do it… whatever “it” is or whoever that “somebody” should be… when in reality, we all have opportunities to be doers, add value to our patients and our co workers. What a great place and Team we have in Roseville.

If you see opportunities to add value and fun with your team, do it!  and when you have time, share it with me.

Where are We?

Recently we have been all over the map… literally to New Orleans, Washington, Los Angeles, Salt Lake City, Dallas, Portland and San Francisco.  Here and there, back N Forth in the past 4 weeks.  During these stops, we have engaged with industry leaders, as well as people like you and I trying to make a positive difference in the lives of people we come in contact with.  We engaged in the annual APTA (That’s the national hob knobbing of Physical Therapists 🙂 to lecturing in SLC, Portland and LA.  This past week, we traveled to SF – CA for the annual IHRSA convention (national sports and rehab equipment trade show).

Through it all, one thing rings clear…The key buzzwords continue to be innovation and efficiency which is code for what technologies will allow us all to see more patients. 

Where and what does this mean for us, is still being debated.  Remember when your Doctor would be able to spend as much time as needed with you?  Now it seems that time is cut to the essential tasks of getting the job done… but what it that “job” and what will it be in the year and years to come?  I don’t have THE answer, but I do know our team is focused on making sure we feel value in our experience. 

Next week, we are moving into a new location in Natomas (by Arco arena) and we look forward to providing great value to our community.  April 1st will be our first day.  Feel free to look us up and stop in to say hello!

What’s the Price?

Shawn Burger…

It’s easy to complain about healthcare pricing.  When I was a kid, I was told repeatedly that there are simply two types of people in this world… those that do things (you may not like what they are doing, but at least they are doing) and those that complain about those that do.  Doers and complainer’s we say in our house.

Needless to say, the constant complaining regarding our healthcare system is confusing.  What really is the point?  I for one don’t have the answer, but I was recently surprised to find out that behind the noise, there are people doing.  Simple solutions to one issue at a time, making life easier for everyday people like yours-truly. 

So what is so interesting that caught my attention?  $4 prescriptions at Walgreens.  You see, last year I had a ‘traditional’ HMO insurance plan with a $10 co pay.  This year, I decided to be a doer and enroll in a HSA were my responsibility is the first $2500 of all health care costs for the year.  My first trip in the New Year to Walgreens, I was shocked to pay only $4 for the same medicine that I paid $10 for the prior month.  What’s the difference I asked?  Simple, the insurance costs more, more people to pay for, more paper to push, more work that costs more money!  When you’re paying “cash,” there is only Walgreens and the patient so the costs are a lot less.

What the… I wanted to say!  But I said thank you with a ‘doing’ smile and went home.  If only our Hospitals were so simple.

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