Environment
Since 1997 I have been telling a story to my patients. This story has slowly evolved, to its present form, over the years. This “evolution” is due to my expanding knowledge and ever broadening experience as a biomechanist.
Where do we come from? In its simplest form the question is one of either evolution or creation. For this story it makes no difference, because the story is only a few hundred generations old.
Growing up, I was taught the theory of evolution. That we crawled out of the primordial soup and eventually walked the earth. I don’t believe that, at least not in the context of the last few hundred generations.
When I look at fossils of humans and mummified remains from the last seven thousand to three million years, I believe I am looking at something that has barely evolved at all. I believe that the only difference between man today and man thousands of generations ago is that we are bigger, bigger because we have better nutrition and no longer need to hunt and gather our food. In my mind that goes a lot farther to explain the last few thousand generations than the idea that we evolved from apes. It is hard to have perspective when the timeframe has all those zeros.
 The central point of how we have evolved is taking place right now, under our feet. Concrete is not a natural phenomenon. We are only the third and fourth generations to walk exclusively on concrete and I believe that this is the major force affecting the evolution of modern man. Man has walked the earth for thousands of generations, and it was not until we invented the automobile in 1897 that we had a use for concrete and started paving everything. Therefore, your great-great grandparents never stepped on concrete, and you and I practically never step off of it. For all intents and purposes, the world we live in is hard and flat. The major evolutionary force of the last few hundred generations is concrete and the way we walk on it.
Think about it from this standpoint. Man has walked the earth for arguably millions of years and, in a time that happens to be greater than our lifetimes, a fundamental and revolutionary change has occurred. It is because this length of time is greater than our own lifetimes that we did not appreciate its significance on “modern man,” especially because it coincides with the age of enlightenment in medicine.
The medical malaise of the last hundred years has changed due to a wide variety of environmental factors, but a major reason has been completely overlooked. Your great-great grandparents never stepped on concrete. And while I am not trying to say that life before concrete was grand, I am trying to point out that there has never been such a profound “evolutionary” change.
I am sure that as life expectancy has increased and people lived longer and longer lives, the orthopedic problems of the aged have not greatly changed, just our ability to actually live longer as the aged. I believe that these problems and the technological advances we have successfully employed to deal with them are applied at the wrong end of the challenge. If we could find solutions to the origins of these problems, we would be able to significantly reduce the lifetime of disability and ever increasing healthcare and societal costs associated with these problems.
I propose therefore that because we primarily interact with our environment through our feet and the way we sit, that the lower extremities and specifically our feet can no longer be ignored as the foundation of the body.
 Furthermore, in regard to the fundamental way we address orthopedic problems, we can make a piece of metal the shape of your hip and knee, but when you get arthritis in your ankles we fuse them because an implant that works has yet to be devised. Why? The answer is not that the motion of the foot and ankle are too complicated. The answer is that our explanation of normal and abnormal foot mechanics does not accurately explain the situation. It’s amazing to think that with all the phenomenal advances in medicine, we can't even agree on where the axes of the foot are.
The problem lies in the ground-breaking fundament conclusions of Drs. Root, Orien and Weed, who in the mid 1970’s wrote what became the bible for lower extremity biomechanics. They stated that the mid tarsal joint, the top of the arch, had two axes, which locked and unlocked the foot. And that it was this locking and unlocking mechanism which accounted for excess pronation of the foot and leg and therefore most of the pathology that they and later investigators felt caused almost all orthopedic problems from the foot to the top of the spine.
I can explain a better working model that is not based on these imaginary axes, and they are imaginary, but on the actual anatomical structure of the foot and simple physics and engineering principles. To this point, my colleagues and I have found this model to work in almost every foot type except those compromised by neuromuscular disease. More importantly these concepts can easily be applied to young and old alike with great success. Furthermore, we have devised a way to measure the foot, which takes the guesswork out of fitting not only shoes that are comfortable, but also shoes that provide the proper support and alignment necessary to balance the body on its foundation. Just because old style shoe salesmen are extinct, doesn’t mean the need for their talent is gone. And today we can apply modern science and technology to this much overlooked aspect of this far-reaching problem.
 What I am speaking of is a way to balance the body from the ground up. Providing stability to the muscles and joints by keeping them in the middle of their range of motion where they have the most strength and stamina. Going back to my previous point about concrete, the obvious conclusion is that concrete is hard, and that in itself is a problem. But that is only the secondary concern. The primary issue with concrete is that it is too flat and unyielding. Before concrete, man walked on a variety of surfaces, with a variety of densities, and what this imparted was a degree of strength based upon this variety of positions. Because the ground wasn’t exclusively hard and flat we developed the muscle balance necessary to function on these different surfaces.
As a simple illustration of how this works, anyone who has been on a modern cruise ship knows that you quickly adapt to the rolling motion of the ship in calm seas. Most people are surprised though to fine that when they get off the ship, their body is still rocking in harmony to the ship they are no longer standing on. To a much greater degree, imagine if your everyday life was filled with these varying terrains. You would naturally have greater strength through a greater range of motion because you would be using a greater range of motion to function in everyday life.
The conclusion is undeniable. When we paved the planet to make it easier for automobiles, in effect we destroyed our ability to adapt to the ever-changing terrain we no longer walk on. Thousands of years of evolution and we hardly changed and then in a point of time a hundred years ago, we changed everything. So… how do we handle this? By pulling up all the pavement? No, the answer, thankfully, is much simpler. What we must do is put something between the foot and the ground that not only fits the foot but that also fits the ground.
This is a fairly common concept in podiatry and to those who make orthotics designed to support the symptomatic foot. But as we have applied it, our ideas of biomechanics go much farther. In our practice we routinely correct patients gait and posture in such a way that most every patient finds relief to foot, ankle, knee, hip, and back pain.
Now obviously modern foot orthotics have been around for some time, and while some people swear by them and the relief they provide, many people find them to be expensive and inadequate, inadequate because of restrictions of shoe styles and inconsistency of results. We believe that what we have been able to do is devise a method that addresses all these concerns, and does so in such a way that we can predict the results we can attain. We do this by incorporating existing technology and existing materials into a device and business concepts, which we believe are completely protectable. The device, which measures the foot and its range of motion, is unique and therefore patentable. And the service we provide could be licensed to manufacturers, incorporated into existing shoe styles, and used to increase human performance in work, leisure and sport.
There are, therefore, a tremendous amount of avenues where these ideas and products can be applied. To name a few; house slippers are a farce and are totally inadequate to providing a comfortable alternative and casual rest from outdoor shoe gear. Infants’ shoes come in hard and soft soles because the manufacturers want to make whatever you think your child needs. Many studies show this is the best time to influence adult position and is certainly a market that would easily accept the latest thing that’s best for baby.
Work boots: try to find any significant percentage of people on a job site that think their boots are comfortable. It wouldn’t take much effort to adapt all existing designs. All pregnant women want longer and wider feet; that’s courtesy of a hormone called relaxin which not only softens the uterus before delivery but, unfortunately, also loosens all of the other ligaments in the body. On the contrary we believe that this is the perfect time to realign the foot and improve the supporting structure of the body.
 Women’s dress shoes; most women wear shoes that are too flat for them. Find another doctor that thinks so. And yet recent studies show that women are wearing lower heel heights in an attempt to be more comfortable. That’s the wrong answer. What woman wouldn’t rather wear more stylish shoes and wear them more comfortably at the same time? There is a reason that women have more foot trouble than men and it’s not because of high heels. Nike is the largest sneaker manufacturer in the world. The beauty of their advertising is that it contains very little talking. That way you are free to interpret what the images mean to you. But what if they could say, “We know what you want and we know how to give it to you.” They can't because they don’t know either, no one does. We can't even explain the proper mechanics of the midfoot, your arch. But I can. And, with this knowledge I can provide stability to the elderly, strength and less injury to the athlete, comfort for women who dress for success, relief for the teen with growing pains which turns into adult arthritis, improved bottom line for the company which has to deal with the loss of employees, and the cost of training and filling their positions, not to mention healthcare dollars, workers comp and lost productivity of key people. What does the military do when a soldier in the field or on a ship gets disabling heel spurs, shin splints or low back pain? What does anybody do for low back pain? Certainly not go to their foot doctor. Why does Medicare pay for preventative foot care for diabetics when it pays for so few other preventative services? Is it the hope that it will reduce the number of amputations or the recognition of the tremendous cost of care for the amputee?
When your feet hurt, you hurt all over! How come we don’t say that when your back hurts, or when your knees hurt? We say this with sore feet because your feet are the foundation of your body and as such are the key to all of the problems I have mentioned and many more. More frightening is the realization that your feet don’t have to hurt for them to cause significant problems higher up the kinetic chain.
What we have discovered is how to keep your feet, and therefore your body, in optimum alignment. The applications for this are tremendous. The amount of money that could be saved, and business generated from the products which employ these principals, is vast. Moreover, the greater good is increased quality of life.
Columbus discovered the world was round and I’m sure when he got back to the docks this knowledge was not met with cries of “atta boy Chris”. I have discovered the world is flat and I believe this news will not easily be accepted either.
-Dr. Robert Levine
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