Summer Footwear and Smart Ankles

Summer has arrived and, on the weekends at least, many of us have replaced our boots, oxfords, heels, and pumps with sandals and flip-flops. We want to lose all traces of the long winter and revel in warm, fragrant summer breezes. The summer experience is enhanced by freeing our feet from their long confinement and exposing our toes to the sunshine and fresh air. The only downside is the potential, for some of us, to suffer a foot and/or ankle injury owing to the inadequate support offered by summer footwear.

From a biomechanical perspective, during the eight months or so of the year that you're wearing regular shoes and boots, your feet and ankles adapt to the configuration and support provided by your footwear. In fact, your feet and ankles come to depend on your footwear and your built-in physiological support systems "dumb down."  As weight-bearing support is being provided by footwear, your innate neurological mechanisms don't have much to do. These integrated networks receive less information, send reduced numbers of signals, and begin to lose cohesion. The summer switch to flip-flops and sandals withdraws the artificial support, and your deconditioned neurological networks are unprepared to provide the critical services of maintaining integrity of balance and gait. The unwelcome results may include foot muscle strains, depressed foot arches, and ankle sprains. Any of these would seriously impact your summer fun.

Of course, our choice of footwear represents our own personal sense of style and may even be situated in a personal cultural context. We do need to be aware of the impact of these apparel choices on our overall health and welfare, and the availability of actions we can take to restore the optimal functioning of our internal physiological support systems. The primary action is to engage in exercises that enhance the function of proprioceptors, specialized nerve cells found in all joints, especially weight-bearing joints such as the spine, hips, knees, and ankles.

Proprioception is your body's awareness of position in three-dimensional space. Your ability to walk is based on extensive training of the proprioception system when you were a toddler. Ballet dancers and gymnasts take years of daily classes in order to obtain the results of highly efficient and robust proprioception. Even tasks such as writing and typing are based on years of similar training. The good news is that the training we need to make a smooth transition from winter to summer footwear is simple and easy.^1-3

The single exercise required is known as the "flamingo" or "stork" exercise, which provides specific training for ankle and foot proprioceptors. You stand near a wall and lightly touch the wall with your fingertips (thus, preventing falls). To begin, stand on the right leg and place the left foot beside the right knee, so that the left knee is bent and facing front. Balance on the right leg and maintain this position for 20 seconds. You'll notice that your right ankle will wobble back and forth as it readjusts to stabilize your weight. Then switch sides, and repeat. This simple method, done two or three times each day during the winter, will maintain the intelligence and awareness of your proprioception system even though you're wearing enclosed footwear. When you break out your sandals and flip-flops in June, right around the summer solstice, you'll be prepared to enjoy the long, sun-filled days of summer.

1. Hall EA, et al: Strength-training protocols to improve deficits in participants with chronic ankle instability: a randomized controlled trial. J Athl Train 50(1):36-44, 2015
2. Hale SA, et al: Bilateral improvements in lower extremity function after unilateral balance training in individuals with chronic ankle instability. J Athl Train 49(2):181-191, 2014
3. Wright CJ, et al: Randomized Controlled Trial Comparing Rehabilitation Efficacy in Chronic Ankle Instability. J Sport Rehabil  2016 Feb 26. [Epub ahead of print]