I read a very interesting article written by a podiatrist about feet.  In the article the author did research on indigenous peoples who do not wear shoes.  He found that 3% of those people had foot problems.  Then the same study was done on modern society.  He found that 78% of the people had foot problems.  I think of the 3% as equal in both populations – these are foot problems that are present from birth; club foot, flat feet, etc. If you subtract the indigenous 3% from the modern society number you have 75% of the population that has foot problems.  That is due to the only thing that differs in walking between you and me and an indigenous person – modern SHOES.

Shoes are made around a form called a last.  The last time that the (shoe) last was really re-engineered was over 150 years ago.  Thus, we are a bit out of date with our thinking.  Make no mistake; shoes are designed for fashion, not function.  Fashion sells shoes.  It amazes me how much pain and discomfort people will put up with to “look good”.

If you read the book “Born to Run” you will notice that the book strongly suggests that we did not really have problems with people running with shoes on until the 1970’s when the first running shoe came on the market.  Those shoes changed the way the foot strikes the ground and that lead to problems.  The design of running shoes still has not changed.  The problems still persist.

One thing your shoes should not do is be straight along the inner edge.  If you look at a babies feet, their big toe is a bit to the middle (medial) from their heel when the foot is straight (it looks a bit like an ape foot).  They can also move their big toe more like a monkey (they can move it toward the middle).  This is normal.  When you start wearing shoes, the muscle that allows this motion of the toe (called abduction) gets weak (atrophy).  After a time it simply can’t move the toe to the middle anymore – it does not have the strength.  This is due to the end of the shoe (the toe box) pushing the big toe against all of the other ones.  Over years the abductor muscle weakens and the adductor muscle (the one that moves the big toe toward the others) gets stronger (it has no opposition).  This pulls the end of the big toe toward the others and the joint (the ball of the foot or the metacarpal/phalangeal joint of the great toe) begins to move toward the middle – away from the other toes.  We call this a bunion.  Notice the cause of the bunion – SHOES.  Shoes that work with your feet (rather than against) will not try to make the inner edge of your foot straight, but will allow it to make the natural curve that nature intended.

Contrary to popular belief, the human foot (when it works correctly) is a self-supporting structure (as in it requires no outside help).  Thus, arch supports are not required when the foot mechanically works as it should – they are not a long term solution to foot pain.  My first recommendation is to get your feet treated by someone who is skilled at getting the bones, ligaments and muscles to work correctly, and then buy shoes that work WITH the foot, rather than against it.

My personal favorite for shoes is a company out of Pennsylvania called Flexible Footwear.  Their shoes are the most comfortable that I have ever owned and their customer service is amazing!

I am also a fan of barefoot shoes.

There is a fair amount of controversy surrounding vitamin D. Experts can’t seem to agree on what form and the dosage of vitamin D that we need per day as humans. I’m going to give you my recommendations, based on the reading that I’ve done, and the experience I’ve had with my patients and myself.

Vitamin D is measured in something called international units or I.U.’s. This is a different standard of measure than traditional milligrams or grams. When we get a vitamin D level from the laboratory, the numbers come back with a range from 0 to 100. Medically speaking, if you have a level that is below 30, you have a condition called hypovitaminosis D. This simply means you have low vitamin D. In the standard medical world anything that is 30 or above puts you in the “normal” range. However, that does not mean you are optimal. The optimal range is 70 or above. It is at the 70 or above level that you really start to feel the benefits of optimal vitamin D.

In many respects vitamin D is not a true vitamin, it functions more like an enzyme. When your levels are optimal, vitamin D can function like a pain reliever. It can also enhance the immune system. It prevents 20 or more different types of cancers when optimal. It can help heal the gut lining for patients with Irritable Bowel Syndrome or other gastrointestinal diseases. It also regulates calcium and phosphorus in the body. This is important for bone health and the prevention of osteoporosis and osteopenia.

Symptoms of vitamin D deficiency can include: rheumatic pains, muscle weakness, gradual hearing loss, and fracture risk in adults. In children it can show up as knock knees, bowed legs, spinal curvature, pigeon breast, skull disfigurement, tooth decay and other dental problems. Significant deficiencies can show up as rickets, osteomalacia, or osteoporosis. Thus, this vitamin is important! Vitamin D exists in two forms: vitamin D2 or ergocalciferol and vitamin D3 or cholecalciferol.  Of these two forms, vitamin D3 is the one we need the most. It is the most active in the body.

As a supplement vitamin D3 comes in a liquid and a powder. The liquids come in two forms, a dropper form and a capsule form. The liquid capsule form is usually based on soybean oil, and should be avoided because of the estrogen mimicking effects of soybeans (it is bad for both men and women). That leaves the dropper form, which is wonderful for children or adults who can’t swallow capsules and the powdered form which comes in capsules and tablets (some of which are dissolvable in the mouth).

When I was first learning about vitamin D, I had some patients who tested it on themselves. They traveled frequently, and often had aches and pains when dragging their luggage through the airport. They decided to take an increased dose of vitamin D before travel, and lo and behold, they had absolutely no pains when moving their luggage through the airport on that trip. As a result I did more reading and learned that what we got taught in medical school about the recommended daily dose of vitamin D was significantly low. We learned that 400 international units should be enough to keep someone healthy. This is incorrect. 400 international units will keep the average person from showing the signs and symptoms of rickets. Their lab tested vitamin D level will come low though.

There is talk now about doubling the recommendation to 800 international units per day. This is still significantly low. Some people take 1000 to 2000 international units per day. However, on a sunny day, when you go out into the sun with exposed skin, your body may make up to 50,000 international units before it decides it’s had enough for one day. When our vitamin D levels are low, we typically get depressed. Medicine has a name for this, seasonal affective disorder. Many of us have a treatment for this; it’s called winter vacation to someplace sunny. We travel someplace during the winter that has lots of sun like Arizona or Florida, expose our skin to the sun, increase our vitamin D levels, and return with much less depression. While I am not suggesting that you change your vacation plans, many of the symptoms of seasonal affective disorder can be alleviated with adequate amounts of vitamin D.

Here are my recommendations for daily doses:

For healthy individuals, 5000 international units per day should be sufficient to bring your levels up into the 70s after taking them for 2 to 3 months.

For moderately unhealthy individuals, people that work indoors, or people who get little exercise, 10,000 international units per day should be sufficient.

For people with osteopenia or osteoporosis, 25,000 international units per day with the addition of vitamin K in the form of MK7 is my recommendation. These patients should have their blood levels monitored, and so I don’t recommend undertaking this dose without the care of the physician.

For very unhealthy individuals, I usually start these people out on 50,000 international unit’s per day for two or more weeks to build their levels up quickly. Again, I don’t recommend doing this on your own without the care of a physician.

For people who have acute illnesses, which can include the flu or viral illnesses, you can safely take 2000 international unit’s per kilogram of your body weight per day for three days. This has the effect of supercharging your immune system.

The current recommendation for children is four hundred international unit’s per day minimum. This is for children of any age group.

Those of you wishing to learn more about vitamin D, please feel free to make an appointment the office.