CAGA 101: The 12 Dirty Truths of Foot Mechanics

Dirty Truth #9: Fashion and Idiocy–Feet Need to Find Their Footing

By Jay Segel, DPM; Sally Crawford, MS

If you have been following our articles, you may have noticed a trend in how computer-aided gait analysis (CAGA) data can help characterize unavoidable and avoidable truths about your 2 feet and the long-term consequences. When it comes to footwear, even research supports the fact that improper footwear and “wear and tear” over time will have negative impacts on foot health¹. In this article, we highlight one of the sadder dirty truths and the one most directly under our own control; “looks good” does not mean “is good,” also known as fashion doesn’t equal function.

Consumer comfort through retail therapy often reverses the priorities of making healthy choices first, followed by taste and style. This dirty truth comes in number 1 for absurdity, when understanding that there are patients requesting that their doctor remove a lesser toe so they can fit into a particular shoe of their fancy. They often additionally remark, but they make me look so good. At that point, we change the focus to the clinical consequences of footwear-driven deformity.

Let’s identify and address perhaps the core of this dirty truth: mental fit versus physical fit, and the need for foot splay–the natural widening and lengthening of the foot under loads. Take the example of shaking hands, a solid, firm but not “too firm” grasp is very satisfying. Our handshake preferences often carry over to the way we judge footwear fit.

During intake with a patient, even before CAGA testing, often the first sign of footwear misjudgment includes comments about–pressure, rubbing, “my toes feel crowded”–and that’s the moment to intervene. The next question is usually  “How long have you had this problem?” And, frequently, patients will respond that they have had the issue for a while.

Upon further query, “Have you sought help for this before?” we often hear, “No, I thought it would get better, before it didn’t look right, but now it’s hideous and painful.” This is a great moment for patient education, not just for them, but perhaps for their children, other family members, and/or circle of friends. If we can help people to seek our advice when first noticed, their issues would not likely progress to the presenting level of deformity or pain. Simply stated, one clear thing is that early intervention can slow, arrest, or reverse deformity and perhaps prevent pain. Henceforth, waiting is idiocy, not logic.        

So, to end with a little CAGA logic: systematic reviews and critical/scoping reviews consistently point to the value of biomechanical assessment, individualized recommendations like personalized fitting, and preventive care for protecting long-term foot health and mobility^2,3,4. The point is not that style and comfort are irrelevant–it’s that, without quantifying function, “feels good” and “looks good” can still create small triggers that snowball into chronic and preventable issues, altered gait patterns, and even visible deformity.

What CAGA adds that subjective comfort can’t is data–objective proof of function, so your footwear choices are based on biomechanics, not just look and feel.