As a runner and now a newbie cyclist, getting the equipment right has been quite the journey! Early in my training journey I knew very little about Ehlers-Danlos Syndrome but I did know that whenever I walked or ran for a long time, I'd get debilitating pain in my knees, hips and lower back which I'd always put down to 'the way it is' due to having EDS.
Little did I know, much of that pain was actually due to not using the right equipment to support my body - specifically in that case, the right shoes and foot support.
Why do people with EDS need to think more about our feet?
Ehlers-Danlos Syndrome results in laxity in the collagen which forms the connective tissue of our body - everything from ligaments and tendons to the fascia which holds our internal organs in situ.
When we're performing in sports, quite often we're putting our body under more strain than usual which in turn means that if our connective tissue isn't functioning so well, the rest of the surrounding structures have to pick up the slack and work much harder.
In some cases, this can lead to unusual movement patterns as parts of the body fatigue due to the higher-than-usual demands placed on the musculature. It can also mean that once those muscles fatigue, we're at much higher risk of injury because we simply can't control our body through ranges of movement any more. The feet can often be the starting point for problems which manifest further up the body.
How can the right equipment help prevent injury?
Here's where I think getting the right equipment can make a huge difference:
- It can help to support the body's natural position through movement where collagen structures are not giving the right amount of structure to maintain it
- It can ensure correct movement patterns by ensuring body alignment throughout repetitive movements
- it can block potentially injury-inducing movements that might come about due to fatigue or unexpected movements
Taking care of your feet
The foot is a complex part of the body with 26 bones forming 30 joints with over 100 muscles, tendons and ligaments that all have to be in the right position at the right time and move in the right ways to enable efficient movement. This includes being flexible and mobile in some phases of the stance, and being fixed and rigid in others. If even a small part of this goes wonky, it can have wide-reaching impact across the body.
How can feet be affected by EDS?
In my case, I learned pretty early on in my physiotherapy training that the arches in my feet were almost completely collapsed leading to pretty severe pronation of both feet - the insides of my feet are almost on the floor when I stand naturally, somewhat resembling a penguin 🐧!
This isn't always the case though, some people with Marfans-related conditions can have the opposite and have very high, rigid arches which create a whole host of other problem that us penguin-footed folks don't experience!
Have a read of this great article on ehlers-danlos.org for a more in-depth dive into all things foot-related!
What can help people with foot problems when training with EDS?
Training your feet
The first step for anyone with concerns about feet is of course to get things checked out by your healthcare professional, but I believe that as a general population, we can all work on improving our foot strength, proprioception and control. Even stretching is important - us bendies are often told that we shouldn't be stretching but my experience has been that overly tight calf, hamstring and quadriceps muscles can cause all kinds of havoc with my feet, so it's important that we're regularly keeping an eye on how our muscles are responding. Whenever I ramp up my running or cycling training, my calf muscles need more of a pummelling to keep them supple!
Some of these exercises can be done from a chair or in bed, so it's something you can start with even if you're not able to be up and about on your feet.
Some great instagram accounts to follow if you want to learn more about strengthening your feet:
Using the right footwear
Depending on what exercise you're doing, the footwear you need will vary and the options available to you might seem a bit mind-boggling if you're new to exercise - I can't emphasise enough how helpful it can be to get the advice of an expert in that area by visiting a specialist shop. You don't usually have to purchase from the shop (in fact I recommend going home and having a think about it so you're not feeling pressured to buy from them). Some general things to think about are:
- Do the shoes fit well? Is there enough room for my feet to expand when they get hot?
- Do my feet feel supported in these shoes?
- Is there any rubbing or tightness when doing the activity I'm going to be wearing them for?
- Do I have enough mobility in these shoes?
- If you have braces/orthotics, do they fit? (this is a big one, often you will need to size up)
Running shoes
If you're running and you're just thinking about shoes or having some problems with your feet, it's very much recommended to visit a local running shop which offers gait analysis and find out what kind of shoe is going to work best for your needs (after reading the sections following).
You can also get specialist running-focused gait analysis done which is very helpful if you have specific issues you need help to correct - read more in my article 'When did you learn how to run properly'.
In my case, I found that I need an extra-wide fitting because when my feet get warm, regular width shoes become too tight. I also use a neutral shoe (Brooks Cascadia for trail and Ghost for road), because my insoles give me the necessary arch support.
Gym / weight lifting shoes
In the gym, I personally find wearing barefoot shoes (I have the Vibram 5 finger Train (Amazon affiliate link) shoes for weightlifting) really helpful as I need to be able to feel the floor and use my feet more functionally - I find trainers too squishy for this. You can also find specific shoes for weightlifting which might be worth exploring if you're doing a lot more lifting.
It's worth considering, however, that barefoot and weightlifting shoes are, for many folks, no good for things like cardio. If you plan to do a workout with running and lifting, be sure to change shoes. Don't force yourself to do high impact work in unsupportive shoes, it's not worth the risk.
Cycling shoes
If you're a cyclist, getting the right shoes is an important decision. Wrong shoes can lead to pain, blisters, nerve impingement and miserable hours in the saddle! Probably the biggest problem is not having wide enough shoes, or having shoes which are too small - each brand has somewhat different sizing so it can be quite hit-and-miss to get the right size. Go and get measured in a shop!
If you're a cyclist and you use cleats, it's very important that you get your cleats fitted properly to ensure the right angles and support for your feet. Most bike shops which offer bike fitting will do a cleat fitting, you might be surprised how much difference it makes, I know I was!
Foot orthoses
While I've spent countless years doing foot and ankle training to improve the strength and flexibility of my feet, unfortunately for me there's simply no way my feet can be trained to sustain the right arches needed for good biomechanical efficiency for long periods of time or under intense effort that is required when running.
I need to give myself more support, through wearing insoles which effectively create the arches for me and ensure that the biomechanics of my foot function as nature intended.
In the first few years I was referred to the Orthotics department at Ipswich Hospital because I also had problems with recurring ankle sprains, and was fortunate to have several pairs of insoles created by their awesome team of folks. They take a moulding of your feet when you step into some foam boxes, send them off, and back comes your customised pair of insoles.
While this was great to get me started, as I began to increase the distance and duration of my runs, I started to get problems with my hips. When I went back to the orthotics team, they decided to try out a different density of insole which allowed my foot to move and twist more during the running cycle, rather than the high-density ones which were holding my arch rigidly.
Here's an old video of me explaining the difference in the two insoles:
It did help quite a bit having the different types of insoles, although I struggled a little bit with the material that the mid-density ones were made of (it gave me blisters with some types of socks!) so it's always worth considering that.
Nowadays I've transitioned over to using 'over the counter' insoles from Sole which seem to work really well for me.
Ankle braces
To brace or not to brace, that is the question! When I was training as a physiotherapist we were often told that braces should be considered as a last option, because they can cause the wearer to cease focusing on rehabilitation and strengthening work, relying on the security of the braces to protect their joints.
While I do feel that this is an important consideration, my own lived experience has been such that wearing the right ankle braces has literally given me my life back!
I'd been through decades of being in and out of ankle rehabilitation with the sprains, ligament tears and other injuries I've had since I was a young child. Literally been there, done that, got the t-shirt! When I started to increase the running I was doing in my 121 personal training sessions, we noticed that I would often stumble or turn an ankle on even the smallest of things - a tiny stone on the path, an errant branch on the track - you name it, it'd cause me to trip over.
I tried taping and also some of the lace-up braces I used with the American Football team I was pitch-side physio for, but I found that these restricted my movement too much to be able to run comfortably.
After a lot of research I came across the Aircast A60 ankle braces (Amazon affiliate link but you can find them in a lot of places online!). They come in black and white, and are famously used by the tennis star Andy Murray so I figured if they're good enough for him, maybe I should give them a go!
I don't think there's a single piece of equipment that has had a more profound impact on my ability to train with EDS than these ankle braces. It's like they were a missing piece of the puzzle that dropped into place. With the braces on, I could comfortably complete all of the running workouts we were doing without any ankle wobbles. I could walk over stones, twigs, branches ... even on the muddy and stony shore of the river ... without even so much as a tweak.
In fact, since wearing these braces I have only badly sprained my ankle once, ironically on a petrol station forecourt right at the end of a run where I turned my ankle on an unstable slab of concrete but what would have normally (without braces) been a lengthy 8-12 week recovery was only a 3-4 week rest period. The sprain was minor, and it recovered very quickly.
They aren't cheap at between £25-40 per side, but they do last years - the biggest area of wear is the white material where it rubs against things - and for me it's a price I'm willing to pay for having the ability to be physically active. Some NHS orthotics departments can prescribe these, and sometimes they're available under health insurance, too. Always work an ask!
In summary
To wrap this up, the feet matter a lot to your ability to train when you have Ehlers-Danlos Syndrome. It's really important that you make sure to take care of them and be sure to get a thorough assessment done if you are having problems with your feet/ankles/shins/knees/hips/back - foot problems often manifest in other places!
A great book which I recommend to everyone who is doing any kind of activity that requires you to be on your feet for any duration, or if you just want to learn more about preventing and fixing foot problems (Amazon affiliate link but you can also find in your local bookstore!):
This book taught me a lot about foot biomechanics and what could be behind the morton's neuroma I developed in my foot when training for my first ultramarathon, and also helped me to understand what contributed to blisters and how to prevent them happening.
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By Ruth Cheesley - Articles
