Jan Bruckner, a professor of physical therapy at Thomas Jefferson University in Philadelphia, strides across campus on a balmy morning, heading for a 10 a.m. appointment at the Human Performance Laboratory. There, Gary Sylvester, one of Bruckner's students, nervously waits. He has responded to her standing offer to examine any pupil who complains of foot pain.There, Gary Sylvester, one of Bruckner’s students, nervously waits. He has responded to her standing offer to examine any pupil who complains of foot pain.
Sylvester frets that his complaint is trivial, and when Bruckner begins the evaluation by asking his age, he is so nervous he snaps to attention. “Twenty-three,” he announces. “All of 23?” says an older woman being treated for a serious foot problem in the same lab. She chuckles, then sighs and listens jealously as Sylvester explains that he runs 15 miles a week. His feet rub inside his shoes, get raw around the toes, and develop blisters. “Anything else?” Bruckner asks. “Any other problems?” That’s it.
She listens as Sylvester describes how he has been plagued by blisters since he ran track in high school. He had come to accept them, but now he has begun to wonder why other runners don’t have this problem. What’s wrong with his feet?
Sitting down to face Sylvester, Bruckner lifts one foot toward her and gently manipulates the joints from toe to heel, focusing on his hindfoot. Clamping the forefoot in one hand and bracing it on her thigh, Bruckner flexes the heel and wiggles it from side to side. It’s a good thing you came in, she says. The blisters are harbingers of real trouble. Structurally, Sylvester’s feet are the feet of the future, the next evolutionary step for humans, but as yet no shoe store stocks sneakers to accommodate them.
Sylvester is far from alone. Bruckner says anywhere from 30 to 80 percent of us have feet like his, leaving many people with a stiff hindfoot that shoes can’t support properly. And after years of clinical practice, anthropological research, and pioneering studies, Bruckner has concluded that biomechanically speaking, there’s no such thing as a normal human foot. Instead there is a spectrum of variations, none more normal than any other. Although everyone has the same basic bones and muscles, the parts aren’t always connected the same way. Biologically, the foot remains a work in progress, and it needs a lot more help from the shoe industry than it’s getting. No part of the body takes more of a beating than the foot. If Sylvester hadn’t bothered to show up today, his blisters could have easily become heel spurs, which could then undermine his ankles and knees. Eventually his minor complaint would have turned into chronic pain. But because he is still young, a simple, custom-made shoe insert designed by Bruckner will save his feet.
Bruckner is a quiet, polite revolutionary driven to save the world’s feet.
She has worked in relative obscurity, refining her theories of the lowest human appendage for 15 years without major grants or corporate backing. Her work has become a crusade. She believes each and every schoolchild should receive a foot evaluation, just as each and every one now gets an eye examination. Prescription glasses are available to almost anyone, she says, so why aren’t prescription shoes? Knowing your own foot type should be as vital as knowing your blood type, especially in light of a recent poll showing that half of all Americans say they suffer from some kind of foot or ankle problem. For one in five, those problems will force a change in activities.
Bruckner wasn’t always a crusader for the foot. As an undergraduate at Barnard College during the Vietnam War, she studied anthropology with Margaret Mead. It was then that she first realized that physical therapy, if done properly, is a form of applied anthropology. “These patients have culture, values, and kinship,” Bruckner explains. Her senior year, she did an ethnography of St. Luke’s Hospital’s physical rehabilitation department and documented the behavior of the physical therapy staff. “And like many anthropologists before me,” Bruckner says, “I studied this quaint culture and went native.” Bruckner enrolled at Boston University for a master’s in physical therapy.
As a graduate student, Bruckner accepted what she was taught, that the foot, a bewildering heap of 26 bones and 23 joints, is a marvelous biomechanical contraption that propels humans with speed and remarkable control—proof of evolutionary adaptation. “I thought it was incredibly cool,” she says.
In May 1977, the year after receiving her degree, Bruckner began working with senior citizens at a nursing home in Rochester, New York. Before long she began to realize that the miracles of evolution didn’t hold up very well. In fact, in far too many people, feet seemed destined to fail. “I got very frustrated,” she says. “My patients had tremendous problems walking.” Once their feet went, they suddenly seemed much older. “I thought, if this mechanism is so cool, how come there are so many people with so many problems?”
After eight years of practicing physical therapy, Bruckner wanted more information about the foot’s biomechanics. She turned to her first passion and enrolled in the physical anthropology program at Indiana University. Bruckner began reading old anthropology studies about bones and joints, work considered irrelevant in the medical community. “I discovered something that they’d never taught me when I studied anatomy in physical therapy,” she says. A few anthropologists had written about a wide range of shapes and configurations of the human foot, variations that modern textbooks never mention. In particular, the shape of the talus bone—directly above the heel and below the lower leg bone—differs widely among humans. Visually, these anomalies don’t amount to much. Mechanically, however, Bruckner suspected they might mean a great deal.
The variations that seemed most important to her occur in a joint called the subtalar, where the rounded talus bone fits into the knobby calcaneus, or heel bone. The bones’ irregular forms usually touch each other at two or three distinct points called facets—flat areas roughly the size of a thumbnail. Bruckner realized that a joint with three facets would be stable and rigid, like a stool with three legs, and would restrict motion and allow more shock to shoot through the foot into neighboring joints. Two-faceted joints, on the other hand, would allow greater flexibility. Three facets looked like trouble and Bruckner wasn’t sure how that variation affected modern humans. It turned out that nobody else knew, either.
To find out, Bruckner needed lots of feet. She began with the dead. Because she taught in the physical therapy department at the university’s medical school, Bruckner had access to the cadavers used in anatomy classes. She dissected the feet of more than 30 bodies and tallied more three-faceted than two-faceted joints. More disturbing, she found that one-third of the bodies had a two-faceted joint in one foot but a three-faceted joint in the other, or vice versa, violating left-right symmetry found elsewhere in the body. In her small but random sample, Bruckner didn’t find a single normal pair of feet.
She began to wonder what happens to the knees, hips, and lower backs in people who have mismatched shock absorbers in their feet. How well would they walk when they reached middle age? She began to suspect that all sorts of aches and pains could be traced down the skeleton to these little-known variations in the feet. A lopsided arrangement in the feet presented what Bruckner called an “interesting physics problem” for the rest of the body to solve.
To continue her research on the living without using surgery, she developed a technique for wiggling patients’ heels to reveal three-faceted joints. But she still needed a live group of research subjects and found them by chance when she filled in as a temporary physical therapist with the Tohono O’odham (pronounced like autumn) tribe of southern Arizona.
The O’odham have one of the highest rates of non-insulin-dependent diabetes in the world. Patients lose sensitivity in their feet and then overlook sores such as those created by shoes that rub. It can take only a month for a tiny infected foot sore to become gangrenous, which can mean amputation.
