Ramon Viladot: "The best footwear already exists: low, with a flexible sole and supportive"

The Course on Foot Diseases that has just been held in Barcelona is celebrating its 50th anniversary. "It is the oldest in Europe, I even think it should be the oldest in the world," says its director, Ramon Viladot Pericé, who together with Antoni Viladot Voegeli, his nephew, direct the Catalan school of the foot and ankle group. They have about 250 professors from all over the world and every year about 150 traumatologists from all over Spain attend the course that in half a century only stopped being taught last year due to covid.

It only failed due to covid

"We have been teaching this course in Barcelona for 50 years: it is the oldest in Europe"

What is the newest in this call?

It is not just this call, but the advances with ankle prostheses are important. They didn't even exist long ago. Right now they are similar to those of the hip, although they are not placed with the same normality as these. They are used for ankle osteoarthritis, which is better tolerated than hip osteoarthritis, so there is less pressure to have them operated on. And we also put them for accident damage, in that case, almost always in young people. Still other solutions are used that are tolerable for patients, such as fixing part of the joint. But the prosthetics are giving very good results. It is an important chapter of our course.

We are forgetting the formal and rigid shoe. Is it good for our feet to wear sneakers?

The footwear must be low, because those that support the ankle, the high-top ones, immobilize excessively. It must have a flexible sole, so that the whole foot moves, and that it is well supported. It is quite similar to the sports shoes that a large majority of all ages use.

The heels, no.

Maximum 5 centimeters. From that height it is considered overload and will cause pain both in the front part of the sole, metatarsalgia, and in the back, heel pain.

Flat feet, bunions, plantar fasciitis, spurs... Are they still the foot problems that give the most bad life?

Bunions are the most frequent pathology. Nine out of ten are women. High heels are a factor against it, but it is a multifactorial pathology, including genetics. White people suffer much more from bunions. But the approach to his treatment is changing. Before, we operated by applying a calculation on a single plane, that of the X-ray of the footprint. Right now we are studying the approach as a three-dimensional problem and the solutions are different. And the results, too. We had a 20% of bad results and recurrences. That is changing.

But it still sounds old, right?

Well, I have been able to observe the spurs that cause us so much pain in human remains from the Bronze Age in Menorca. I analyzed the calcareous of 300 people from the same period and 84% had ossified tendons, heel and sole spurs. Probably due to the evolution of standing. The twin falls short. In fact, this is what happens in 40% of current cases. For this reason, before considering an operation, rehabilitation must be carried out.

What about flat feet? There is more?

No, there is a different approach. There are not as many templates as before. In fact, in general, it would not be necessary to think about whether or not there is flat foot before 4 or 5 years of age. But now you're much more selective about using that fix. It has gone out of fashion, as has happened with orthodontics in all mouths.

Have our foot problems changed?

No, the treatments change more. Patients come to us for three reasons: because of pain, both in the front and back of the foot, the sole and the heel; due to gait disturbances, they begin to limp, inflammatory problems, for example, and because they have difficulty putting on shoes. In the latter we have improved a lot. Comfortable shoes will not know.

Does the extension of the sport bring new problems?

We see many injuries related to sports and sports shoes. And a lot of plantar fasciitis.

Do you think we should go barefoot more?

The foot has many joints and inside the shoe we end up moving few. We should go barefoot more, but on uneven ground, to move everything. For example, on the sand of the beach.

Have you ever seen a foot bound to keep it small?

Yes, on one occasion I once met a woman in China with her feet deformed by bandages. She was in tremendous pain. Mao finished that.

Why might they be attractive?

There are many theories: some, because it allowed the control of the workers in the field, they could not run away; another, that forced to move the hips a lot in the dance; also that it was believed that the size of the vagina was related to that of the foot and if it was small, the pleasure would be greater. Ultimately, there is a choice.

Have our feet grown a lot in these 50 years?

If something. More to women. They can ask for a 42 in the shoe store, although not always, of course.

Now that you are celebrating 50 years at the head of the course inaugurated by your brother Antonio, now deceased, and you, do you remember any special moment?

Rather a moment of great rush. We had a renowned Japanese surgeon, Dr. Takakura, on the course. We took him to eat at a wonderful Catalan food restaurant near the Sant Rafael hospital, where the course was taking place. And I suggested eating rabbit with snails. The snails already looked at them with some apprehension. With the rabbit, he couldn't take it. For him it was a laboratory animal. They removed it, of course. He was scared.