About Dr. Novella

(An overview of the goals and subject matter covered in LD181. What inspired me to propose this course to Fashion Institute of Technology in 2003, a course which is now in its 14th iteration and to my collective knowledge, unavailable elsewhere in the world.) 

Sample slideshow of examples of the latest and most innovative, intelligently-designed athletic/dance footwear. Basic athletic footwear nomenclature. Term schedule of classes presented. Students discuss their background and reasons for taking this course. Definition and rationale of body planes, categories of movement, basic anatomical terminology including body regions, muscle, tendon, ligament, nerve, specialized sensory apparatus, and types of joints. Specialized nerve endings and their implication in sport and sport shoe design. Reflexes. Begin discussion of basic anatomy and ergonomics, starting with the foot, punctuating when appropriate with elements to be considered in athletic shoe design. Introduction to injury.

Simplification of the universal format for anatomic nomenclature. Definitions of, and explanation of how muscles, nerves, ligaments and tendons work. How tissues adapt or can be injured. Anatomy of the foot and leg. Introduction to biomechanics. Introduction to the effect shoes have on the musculoskeletal system, and priming the awareness of the influence of shoes on the efficiency of performance. Continue discussion of basic lower extremity anatomy and ergonomics. Detailed discussion of ankle mechanics, particularly with respect to energy savings, injury and heel-drop. Introduction to the role of evolution and ankle mechanics. Open vs closed chain function. Begin discussion of common athletic-shoe features and how they relate to foot anatomy and function. Introduction of awareness that shoes can hurt as well as help.  Introduction to concentric and eccentric muscle contraction. Multiaxial joint movement such as supination and pronation. Foot axes of motion and cohort postural/pedal (foot) influence. Discussion of the relationship of some common injuries and shoe design. Heel counters and their functions. Intro to the concept of motion control. Intro to the concept of when orthotics and arch supports can hurt. The calf as bungee cord. Insole design gremlins. The “Achilles protector” and retrocalcaneal bursitis. Haglund’s deformity and shoe design. Plantar fascial injury and its details. “Painful heel syndrome”. Individual characteristics of each metatarsal. Shoe fit peculiarities for high arch and low arch feet. The five cardinal sport surface characteristics. 

The influence of evolutionary traits upon human structure and movement as they are trying to adapt and readily evolve during the current less than 0.1% of our time on the planet as a species in the industrial era. How this relates to injury and energy conservation from the perspective of caloric acquisition which still demonstrates tenacious characteristics in the make-up of our species dating back hundreds of thousands of years. The role of our tenacious evolutionary traits upon balance, strength and speed; its role with respect to injury; footgear design with respect to evolution; the concepts of techno-burst evolution and genetic modification; the importance of “subtle” in shoe design and performance analysis; heel counter, shank, upper, foxing, laces, lasts, weight, outsole, midsole design and materials with respect to evolution, function, and sport-specific shoe design; foot and ankle anatomy and function; subtle and obvious joint ranges of motion and their influence upon performance, injury and shoe function and design; energy conservation and footgear design; rocker soles well and poorly designed and the favorable or unfavorable influences have from individual to individual; pronation and supination, definition, whole body interactive influence, benefits and disadvantages and appropriate/inappropriate times during activity for their influence; flex creases and how they can be designed into the sole for advantage, and how certain individuals can be influenced favorably or unfavorable by flex-crease design, in terms of performance enhancement, stability, energy conservation, therapeutic influence upon injury, and facilitation of injury; spinal, sacroiliac, hip, thigh, leg, and joints of the lower extremity and their interaction with sport, sport shoes, and injury with respect to many different sports; nomenclature of the spine and its different curves, the interplay of the spine with the lower extremity, footgear, and specific sports; sacroiliac considerations, leg length differences and its various types, and the influence of less than perfect quality control in manufacture on the individual’s biomechanical well-being.

Introduction to basic gait concepts. The special influence of shoe design upon the hip flexors, adductors and abductors. Review varus and valgus influence. Detailed discussion of pronation and supination, and footgear influence upon same. Detailed analysis of subtalar joint on posture and the influence of posture on the subtalar joint. Review types of muscular contraction. Runner’s varus. Open vs closed chain biomechanics.  The biomechanics of the javelin throw. Initial overview of human gait and breakdown into its simplest component parts. Description of each component part from a whole-posture overview. Hip/subtalar interactions during component gait phases. Energy savings during human gait and adverse or complimentary influences of footgear upon same, with particular respect to soccer, basketball, volleyball and ballet shoe construction. Comparing running vs. walking. The Magic Moment of gait about which 40% of performance energy depends, and detailed discussion of footwear's influence upon the Magic Moment. Begin in-depth, complete analysis of all hip and lower extremity muscles during gait, and the complimentary or inhibitory influence of footgear upon same. Patellofemoral alignment and influence of footgear upon same. Force reduction and eccentric hip rotator and abductor function. Effects of excessive or inadequate hip rotations. Effects of soccer cleat selection on hip rotation. Gender specificity and hardwood court outsole selection with respect to hip rotation. Influence of footgear upon hip flexors and hip abductors. Iliotibial band syndrome and athletic footgear influence. Consideration of a runner's training speed upon athletic shoe construction. Femoral neck angle and energy conservation.

Continued comprehensive view of the gait cycle which is subsequently broken down into individual components. Continued discussion of functional influence of all muscles upon each of the phases of gait. Muscles of the foot. Sesamoid function. Bunion formation. Hallux rigidus and how to cheat around it with purposed footgear elements. Adverse consequences of hallux rigidus. The quad/psoas kick and energy conservation. The midfoot muscle gauntlet. Individual and cohort role of anterior and posterior leg compartment muscles. Integration of shoe influence into each phase of the gait cycle. Biomechanical nuances of joint shapes and cohort muscle action upon gait efficiency, and the role of footgear design upon these subtle influences. Subtle joint biomechanics and its role in energy-efficiency, and the deleterious or enhancing effect upon it from shoe design. How the big toe joint saves energy like the pop-top on a Grolsch bottle cap. Close-pack vs loose-pack. Metatarsal length patterns and premature arthritis of the great toe joint. Common injury and age-related acquired foot pathology and their influence upon efficiency; the role of footgear upon enhancing or further impeding this efficiency. Common compensation for sprained ankle and how footgear can exacerbate subsequent injury. Differences between running and walking. Introduction of orthopedic shoe modifications into mass-access shoe design. Integration of all elements of the gait cycle. The determinants of human gait. Illustration of the influence of compensation upon the gait cycle. Responsibility of footgear with respect to gait compensation.

Detailed analysis of the biomechanics of running. Initial discussion of minimalist or “barefoot” running. Introduction of the concept of adaptation. Marketing shoes with respect to adaptation and compensation. The concept of runner’s varus revisited. Starting blocks. Gradient running and the influence of shoe design. Allergenic materials in shoe design. Wicking. Characteristics of sport surfaces, including coefficient of friction, hardness, compliance, rebound resilience, force reduction, and the properties of natural sport surfaces, all with respect to athletic footwear design. Overview of sport-shoe biomechanics to date. Introduction to the modern sport shoe era. Athletic footwear marketing subcategories, including market shares by manufacturer, genre. Important features of running shoes, including design and material characteristics of the outersole, midsole, innersole and sock liner. Midsole construction architecture. Heel drop. Types of both construction and internal lasts. Growth spurts, age groups, specifics of shoe design with age groups, growth spurts and growth plates considered. Analysis of childrens’ athletic shoes from various manufacturers. General categories of running shoes. Running shoes then and now, contrasting early and modern footgear for numerous sports. Begin discussion of the Adidas running shoe line. Review for midterm exam may also take place this evening, depending upon time spent during lecture. Overview of human locomotion and its techniques for energy conservation. Review for midterm exam.

Weight/durability/force reduction/rebound return characteristics of various midsole materials, including polypropylene, gel polymer, closed-cell polyurethane foam, pneumatic, ethylene vinyl acetate, and the new open-cell thermoplastic polyurethanes. Arch bridges and arch locks. Kevlar, and mixed density midsoles. Crash pad technology. Discussion of shoe shapes and foot shapes, and theories behind construction lasts and performance efficiency. Shoe profile. Pressure points upon the foot to be considered in shoe design. Broad categories of running shoes including, cushion, stability, trail, and motion control. American College of Podiatric Sports Medicine listings of approved running shoes by manufacturer in each category and evaluation of exemplary representatives. Evolution of the Saucony Pro Grid Omni flex crease. Light weight trainers, cross country shoes, steeplechase shoes, shoes with spike plates and in-depth discussion of characteristics of shoes for each track, field, and throwing event. Specialized shoe design with respect to the biomechanics of throwing (discus, hammer, shot put) shoes, high jump, pole vault, javelin, and steeplechase. Megacushion shoes. Specialized construction in pediatric athletic footwear introduced. Introduction to the history of the athletic shoe, discussion of the origins of todays major athletic shoe manufacturers. In-depth examination of 30 current running shoes. Overview of the history of the running shoe, with emphasis on iconic examples, examples of shoes which caused injury, examples of shoes which initiated landmark change in the design of running shoes, market shares of running shoe companies. Techniques used by running shoe companies to advance their design, including force plate, video, ergonometric video studies using joint markers, and printed shoe technology. Amalgamation of 20-30 medical journal articles (American Journal of Sports Medicine, Journal of Applied Physiology, Journal of Orthopedic and Sports Physical Therapy, Science, etc.) to reveal practical and evidence-based data relating to athletic shoe design, manufacture and sports physiology.

Evaluation of the minimalist shoe trend across all sports. Comparing ergonomic design differences in minimalist running shoes through several different sports to reinforce awareness of biomechanical differences between these sports with respect to shoe design. emphasizing road and off-road running. Research on minimalist running theory, validity of theory, debunking lore and myth via on evidence based studies. Balancing injuries caused vs performance enhanced through minimalist running. Adaptation to avoid injury. Again, using topics covered in earlier classes, comparing minimalist shoes, barefoot running, and heel strike running. Extensive discussion of the concept of barefoot running and minimalist running shoes. VFF shoes. Nike’s role as innovator. Latest university research upon energy consumption and injury rate.

Topics will include an in-depth discussion of boxing shoes, the boxing ring, cycling shoes and pedals and designs for the important categories of cycling. Choosing a cycling shoe. Tibial torsion, patellofemoral malalignment, and Speedplay vs fixed pedals. Discuss motocross, motor racing, wrestling, Frisbee, lacrosse, tug-o-war, aerobic and skate shoes. Continued expository discussion of the origins of common athletic shoe manufacturers. In-depth biomechanical analysis of each sport with respect to sport shoe manufacture.

An in-depth discussion of the construction and design characteristics of the soccer shoe. Lace covers. Lace bias. Last shapes. Biomechanics of soccer. Goalkeeper’s shoes. Energy expenditure training versus playing in a match. Most common sites of soccer shoe deterioration. Types of soccer shoe upper materials both natural and synthertic. Special considerations in soccer cleat design for the adolescent player, as well as analysis of cleat length, shape, soccer pitch specificity, cleat placement, and the cleat’s effect on both forward and rotational coefficients of friction. Injury analysis with respect to the soccer shoe. Analysis of the soccer shoe chassis and discussion on ways to improve its efficiency. History of the soccer shoe. New concepts in soccer shoe design. Iconic manufacturers. Printed shoes. Futsal. Discussion of American football shoes. Shoes and foot types for linemen, running backs, wide receivers and kickers. Biomechanics of the field goal kick. Discussion of potential design innovations in cleat patterns, including different patterns for wide receivers vs cornerbacks. History of the soccer shoe and the American football shoe. Differences between cleat patterns of football and rugby shoe. Extensive discussion of artificial versus natural playing surfaces and their common hazards, injury, uses, and economics. MRSA infections and artificial turf. Continued expository discussion of the origins of common athletic shoe manufacturers. In-depth biomechanical analysis of each sport with respect to sport shoe manufacture.

Biomechanical demands of the elite vs novice tennis player. Tennis category key market comparison. Tennis World bestseller model construction and user review comparisons. Analysis of the particular construction, materials, tread and other requirements for footgear for the following sports: platform tennis, squash, racquetball, handball, table tennis, and badminton, as well as various hard court surfaces, Har-Tru, classic clay, grasses, and carpet tennis, with particular attention to force reduction, energy efficiency, coefficient of friction, spin, bounce height, bounce predictability, sticking, upper stability, toe cap protection, and upper/sole bonding. Analysis of trademarked Nike construction elements. Discussion of the construction elements of the various racket court surfaces. Axial uncoupling. Sagittal stability. Trends in upper construction and materials. Significance of the shoe’s profile. Characteristic racket sport injuries and the role of the shoe in injury cause/prevention. Discussion of comfort in racket shoe design. A history of the tennis shoe, selecting iconic examples in depth. The origins of tennis. Vulcanization. In-depth biomechanical analysis of each sport with respect to sport shoe manufacture.

Types pf basketball shoes. Basketball shoes for position players. Gender specific basketball shoe criteria. Wicking, toe protection, shank stability, coefficient of friction, profile. Analysis of basketball shoe construction, using iconic models. Trending in basketball shoe design. Evolution of the KD shoe. Streetball shoes. Shoes purposed for unstable ankles. History of the basketball shoe, noting iconic examples. Biomechanical differences with respect to midsole and outsole design. Tread design for basketball. Minimalist basketball shoes. Referee shoes. Biomechanical differences between volleyball and basketball, and subsequent illustration of design specifics for shoes of each sport. Requirements of the volleyball shoe based upon player movements specific to this sport. Addressing these requirements with shoe construction. Sport shoe design and brachymetatarsia, isometatarsia, and macrometatarsia. Manufacturers examples for each foot proportion type and how to spot these types. In-depth biomechanical analysis of each sport with respect to sport shoe manufacture.

Biomechanical differences in potential shoe design for outfielders, infielders, catchers, pitchers and umpires. Baseball vs softball cleats. Turf baseball shoes. History of the baseball shoe, Changes in cleat design over the years. In-depth discussion of golf shoes. The biomechanics of the golf swing with respect to footgear design. Spike selection and turf conditions. Innovations in closure systems. Minimalist golf shoes. Golf sandals. Children’s golf shoes. A brief history of the golf shoe. Cricket shoes. Analysis of batsman and bowler biomechanics and selected cricket cleat design. Mainstream shoes adapted from athletic shoes. Continued expository discussion of the origins of common athletic shoe manufacturers. Rope-climbing shoes, weightlifting shoes. In-depth biomechanical analysis of each sport with respect to sport shoe manufacture.

Presentation targeted to wardrobe designers, shoe designers, health professionals, choreographers, and of course, dancers. Raising awareness of the role of the shoe in initiating and perpetuating injury, being able to spot that role, correct it, and more importantly, pre-empt it. Biomechanical requirements of the ballet dancer, tap, Flamenco, Highland, hip-hop, Lindy, Broadway, and ballroom dancer. Presentation includes examples of occult, shoe-driven injury causing loss of work time; ballet slipper construction; history of the pointe shoe, pointe shoe fitting, construction, selection, modification, and determining a shoe’s useful life span; Irish dance shoes, injuries, and potential modifications and improvements in manufacture; determining the heel profile of a character, tap or jazz shoe, and correlating it with the particular physical needs of the individual dancer to prevent injury; injuries caused by inappropriate heel profile; foot types and heel profile; the role of brachydactyly and common shoe-related injury; common compensatory dance injury and the role of the shoe; axial uncoupling; the dead jazz shoe and the dead pointe shoe; injuries from split-soled jazz shoes and from jazz sneakers; spillover sole; last shapes; tap and Flamenco shoes; eight important characteristics of the dance floor.

This has proven to be one of the most enjoyable classes of the term. In this class teams will display and describe shoes which illustrate and embody their reasons for taking the course. Many of the students designs are impressive for their innovation, adaptation of principles learned to mainstream shoes or athletic shoes, display of their comprehension of the course material, or their artistic beauty (not a requirement). It is not unusual for a student to “teach the teacher” in this class, where we invariably all learn something new. This session will involve each team displaying their designs to the class and describing each with particular attention to the principles learned in the course and any features which the team members feel may make their shoes unique or an improvement to current design. The class will then participate in an open discussion of each shoe, offering criticism or praise, or general comments, as the case may be. Students will thus submit their "Final Project Drawings." Each team will create three shoe drawings for the term, which the team-appointed student will describe. Each team member will ideate one of the three shoes. The class members will have the opportunity to critique the designs of each team. The drawings will consist of three athletic footwear designs, each in a different sport. Alternatively, mainstream and fashion adaptations of athletic shoes may also be submitted, but the design principles learned in the course must be adhered to and described. A team may also opt to depict what could represent an ideal walking shoe, with individual requirements/tastes pointed out accordingly. Students are encouraged to create a personalized logo and incorporate counter, etc.)

A total of ½ cumulative time of one class (50 minutes) will be allotted during the school year for students to use our Keynote presentation and describe their favorite shoes. Up to three students per germaine lesson will be invited to speak. students are advised to think of a favorite shoe they would like to describe in class. Each student will select three favorite shoes, one from one of each of the following genres: traditional running, track and field, minimalist running, martial arts, tennis, other racket sports, soccer, American football, hiking, skate, snowboard, cycling, crosstrain, baseball, ice sports (one only representing: bobsled, skeleton, luge, or curling), lacrosse, rugby, cricket, mountaineering, basketball, and volleyball. The shoe should be the latest design of the particular manufacturer, and it should be an example of new, latest, intelligent, innovative technology. Students will then e-mail me the exact manufacturer’s name and model number and sport of each of these three favorite shoes, telling me the order of their favorites, such as the KD is my first favorite, the Pro Grid Omni 14 my second favorite, and the Ecco Biom ’16 Spikeless is my third favorite. I will look at all the shoes everyone has sent me, and assign just one shoe, based on a first-sent-first chosen basis, trying to give the student her/his most favorite shoe. Once the shoes are assigned, each student will have four weeks to prepare a presentation of no more than four pictures in pdf, PowerPoint or keynote format. I will sort out any compatibility issues so the class can see the presentation on the assigned evening. The presentation will highlight the important and noteworthy characteristics of the agreed-upon shoe, using the pictures for clarity. Presentations should average five minutes in length. This is a very enjoyable facet of the course, as traditionally students have been very passionate about their favorite shoes, they point out features which I and other students may not have noticed, and it gives those students who may have been shy about asking questions in class the opportunity to “break the ice” and feel freer with class discussions.

Presentation targeted to wardrobe designers, shoe designers, health professionals, choreographers, and of course, dancers. Raising awareness of the role of the shoe in initiating and perpetuating injury, being able to spot that role, correct it, and more importantly, pre-empt it. Presentation includes examples of occult, shoe-driven injury causing loss of work time; ballet slipper construction; history of the pointe shoe, pointe shoe fitting, construction, selection, modification, and determining a shoe’s useful life span; Irish dance shoes, injuries, and potential modifications and improvements in manufacture; determining the heel profile of a character, tap or jazz shoe, and correlating it with the particular physical needs of the individual dancer to prevent injury; injuries caused by inappropriate heel profile; foot types and heel profile; the role of brachydactyly and common shoe-related injury; common compensatory dance injury and the role of the shoe; axial uncoupling; the dead jazz shoe and the dead pointe shoe; injuries from split-soled jazz shoes and from jazz sneakers; spillover sole; last shapes; tap and Flamenco shoes; eight important characteristics of the dance floor.

What makes a dancer? A day in the life of a dancer; a day in the life of an injured dancer; basic dance terminology and choreography; norms of range of motion in the dancer’s foot and ankle, how to evaluate them, how to determine if deviation from these norms is contributing to injury; the ballet class; strength considerations; the role of the flexor hallucis longus; metatarsal length patterns; femoral neck anteversion; adaptation; the female triad, hydration and fatigue.

A two-hour presentation expanding upon the principles detailed in Dance Medicine I, paying particular regard to common dance injuries to the foot and ankle, their treatment, compensatory injury, and exploring the history and physical with respect to the dancer.

This 80-minute laboratory is targeted to health professionals interested in treating dancers. Teams split up and are instructed in techniques to evaluate dancer’s foot and ankle strength and range of motion correlative to choreography and common injury.

This is an eighty-minute seminar lab in which elite ballet students learn principles to help maintain healthy feet and ankles throughout their careers. Topics include: common dance injuries to the foot and ankle; keeping a history of changes in your routine; when should I see a doctor? screening for the right doctor; what to say to a doctor; what to expect from a doctor; recognizing infection; immediate care for your injury; maintaining ankle and foot strength; proper street shoe selection per the individual dancer; fitting and discarding pointe shoes; ballet slipper selection; toenail maintenance; padding your foot for injury; pros and cons of cortisone shots; advances in tissue regenerative therapy; do I need orthotics? warts vs corns vs calluses vs ulcers; neuromas.

This 45-minute lab is a version of the ballet school lab, but directed to the teacher. Included are common injuries and their cause and prevention; immediate care for injuries; evaluating and maintaining strength; evaluating a dancer’s limitations and modifying a dancer’s class appropriately; pointe shoe fitting; toenail maintenance; recognizing common skin problems in dancers.

Target audience: third year podiatric medical students. Includes taking an athlete’s history, evaluating gait, sports performance, strength, flexibility, range of motion, shoes, as well as X-rays, MRI, ultrasound and clinical tests. Intended to facilitate spotting deviations into morbid tissue overuse, with particular attention paid to compensatory injury.

Definitions. Envisioning the orthosis and its complete configuration before initiation of treatment regime. Craftable vs non-craftable orthoses, indications and techniques for each. Selecting custom vs otc orthoses. Responsibility of the practitioner. Critiquing the orthotic lab. The subtle difference between indications vs uses for custom orthoses. Advantages of revising a patient’s approach to overuse, or of physical therapy, to prescribing orthoses, when indicated. Evaluating for ideal heel profile of a shoe for each patient. Compatibility of envisioned requirements of orthoses with patient’s musculoskeletal status. Forefoot-rearfoot-leg-knee-hip frontal plane relationship. Subtalar and midtarsal joint axes and their interrelationship with respect to orthoses, foot and whole-body mechanics and pathology. Material selection. Types of custom and otc ankle-foot-orthoses and their indications. Critiquing an orthosis. Assuring that what you ordered has been provided by the lab, and correcting for same. Parameters of orthoses. Interpreting your physical exam with respect to the orthotic order form. Differing orthotic outcomes dependent upon casting techniques. Injuries caused by orthoses. “Boiler-plate” orthoses. Over-prescribing orthoses. Durability of orthoses and debunking the myth of dispensing new orthoses annually. Ethical considerations when offering orthoses to patients.

Perennial Workers Comp injury surveys; the influence of the pandemic on shedding injuries carried over from season to season; the effect of virtual medicine on realizing health goals; the unforeseen prevalence of injuries more common in dance neophytes now occurring in seasoned dancers; loss of adaptation; season repertoire modification to prepare for sudden quarantine of ensemble members; makeshift in-home dance surfaces; why are dancers reluctant to report injury?; the less-injured substituting for the more injured; why is a Broadway gig so coveted?; why is it rare to diagnose just one injury?; compensation; generic factors predisposing injury, including hydration, repetitive strain injury, choreography, fatigue, floors, female athletic triad, smoking, and shoes; returning too soon from injury; returning too quickly after the pandemic; rapidity of return to dance injury prevalence mitigated by a dancer’s age; performing multiple roles to substitute for quarantined dancers; reluctance to turn down roles; resting an injury: how long is too long, how long is too short?; typical musculoskeletal compensation for selected injuries; the pedigree of compensation; typical mistakes in remediation of injury; absence of comradery; no roles scheduled during lockdown, thus unaware of upcoming role and proper preparation; rush to resume high level activity before opening day; disappointment when newly acquired injury prevents return after the long hiatus; others take on their roles, the cycle of substituting and doubled-up overuse returns; mercifully short seasons; recognizing adaptation and perturbed equilibrium.