Monthly Archives: September 2007

A Well Made Shoe Should Last Years

I see this at least once a week and this problem is not only unnecessary but also seems to be gender neutral. In walks a patient, with an otherwise very expensive ($400+) or even an inexpensive (<$25) pair of shoes, having an almost irreparably worn down heel.

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Don’t let this be your shoe. Instead, march your excessively worn heels directly to your local shoe repair shop. They’re professionals and for less than a bargain matinee and a large bag of refillable popcorn, they can create a good as new, flat level heel. Now isn’t that worth it?

In San Francisco’s Financial District, check out Jack’s Shoe Service (415.989.9434) or Anthony’s Shoe Service (415.781.1338). I have used and recommend both. Check em’ out.

Running Shoes – Forefoot Outsole Flex Grooves

A runner came in today with a moderately worn pair of Asics running shoes. Having solved her left heel pain with orthotics some time ago, she was now in my office because she started having increasingly painful ball of the foot pain during her runs.

A quick runway walk down my hall in her Asics shoes showed a stable rearfoot with no excessive pronation in site. Her orthotics were performing like a dream, so that couldn’t be it…what then? Had she changed her mileage or running surface?…No. Had she started to run at a different time of day?..No.

I thought to myself, there had to be a hidden clue – something telling about her shoes. And for me, this is where the fun comes in. I had her shoes off in a flash and got to work. Bending, flexing and twisting her shoes. Vertical heel counter – check. Proper volume – check. Mesh over her bunion – check. and then I saw it, like a lazy snake in the grass. What about the shoes outsole flex point? Could that be the problem? Yes, yes, yes!

Sure enough, when I had her put the shoes back on, I realized that the ball of her foot lay directly over the flex point. Furthermore, this area had no overlying rubber on the outsole and was simply soft EVA, which is pumped full of air for lightness but not necessarily shock absorption. Aha, that was it, the shoe was bending up at at the forefoot flex point, which hammered the ball of her foot against the ground.

This was confirmed by the fact that I had her bring her prior running shoes in which had two flex points instead of one. And neither flex point on the old shoe was centered across the ball of her foot. Another shoe success story, another injury averted and another happy patient.

Take home message – New onset foot pain is not normal. First check the feet and if they’re fine, then check the shoes. Every little thing counts, and you have to be your own best advocate and intimately get to know your shoes.

Cycling Shoes – Cleat Placement

An interesting week, two separate cyclists, two separate injuries, both caused by cleat placement. As an aside, this is a shameless plug for my friend, Jerry Durham who also happens to be an extraordinary Sports Medicine Physical Therapist and maniac Century cyclist. If you’re a cyclist with injuries, need rehab or want a custom bike fitting from someone who knows and understands the biomechanics of cycling better than anyone I’ve ever met, then Jerry is you guy.

Cyclist #1: Numb toes only when cycling distances beyond 14 miles. Return of sensation usually complete by next morning. Hills, speed or terrain don’t affect onset, but distance does. Evaluation of his cycling shoes, showed that they fit perfectly.

Evaluation of his cleats, showed that they were not positioned squarely under the ball of his foot but had been moved forward by the bike shop. With a forward positioned cleat, the push down part of his stroke shifted his body weight in the shoe and because the forefoot of the cycling shoe angled up, when his body weight pushed down, it caused his forefoot to flatten due to the forward cleat placement. This in turn caused nerve compression, leading to numbness. Once we moved his cleat back the numbness stopped.

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Cyclist #2: This patient presented with a stress fracture right, 2nd metatarsal shaft (midfoot). Patient started riding to work 20 miles both ways, 10 miles downhill in the morning, 10 miles uphill after work at 5pm. Patient pushed himself harder and harder during the end of day ride and pleased with his efforts (and screaming endorphins), he decided to train for a Century ride. Committing to a new personal best each day, it was no wonder his foot was the only injured body part. Evaluation of his cycling shoes showed the exact opposite cleat placement from the cyclist above.

Take home message – Check your seat height and check your cleat placement. Oftentimes, cycling ball of the foot numbness can be alleviated with Superfeet, but if not – check where your pedal clips in.

Peace out.

Three Strap Sandal Adjustment

I had a patient come in yesterday with a great pair of 3-strap adjustable sandals. When I had her slip them on and walk, I was amazed at how poorly they stayed on her foot. Walking down the hall, her heel was slipping sideways and her arch appeared to drag nearly on the ground. Because none of us spend much time adjusting straps when we purchase sandals, the following is a brief instructional on a one time correct fit maneuver. Once done, you don’t have to adjust again. This simple adjustment sequence can mean the difference between comfort and sloppy.

If you have a sandal with one of the straps being behind the heel and the other one or two over the top of the foot, you always need to fit it to your foot as follows.

Open up all straps and make sure your heel to ball fits the heel to ball of the sandal correctly.

  • Start securing straps at the toe first.
  • Secure anke strap next
  • Heel strap should be secured last.
  • Leave forefoot and heel strap alone and use ankle strap to get in and out of shoe.

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    Perfect Prada’s – Heel & Vamp & Adjustable Upper Straps.

    First thing Monday morning, my very stylish patient Anne arrives to pick up her new running orthotics when lo and behold, I see that she is wearing a stunning pair of Prada platform heels.

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    Reasons to Love Anne’s Shoes:

    1. Platform design gives the illusion of added height without actually adding height.
    2. Platform sole and heel are wooden and very stable (think Dr. Scholl’s wooden sandals).
    3. Heel style comes straight down from counter of shoe. If given a choice, this will always be better heel design than say a kitten heel or other off center style heel.

    Nordstrom Men’s Shoes – Merrell Jungle Moc

    While shopping with my husband this afternoon I looked down at his heels and noticed, he was like one of the cobbler’s children without any shoes. He was walking on the outside of the heels of his shoes to the point that he looked like he had a limp and was hobbling from side to side. When I asked him how he could possibly walk pain free in his shoes, he replied, “I can’t, so we won’t be shopping for long”.

    Fortunately we were right next to Nordstrom and could buy new shoes, because we had a lot of shopping to do. Once in the men’s shoe salon I quickly wandered around and found him the following three pair of shoes. My husbands challenges are that his foot is very deep and he has a long heel to ball. Lace styles suit him best, but he is drawn to slip-ons because of the ease of getting them on and off.

    He wears orthotics for functional hallux limitus, i.e. sore big toe joints and is most comfortable when the shoe is torsionally stable and has an inflexible forefoot sole. Within 5 minutes, I had the following three contentenders in hand.

    1. Mephisto Gaham – Size 12
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    A very handsome tie shoe, wide and deep – Sticker price – $395
    2. Ecco Montreal – Size 46 Euro
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    Beautiful slip on shoes – Sticker Price – $275
    3. Merrell Jungle Moc – Size 12
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    Wide and deep, very orthotic friendly – Sticker Price – $79.95

    Much to our dismay, when the shoes were retrieved, my husband was unable to fit his orthotics into the shoes. Although all shoes had removable foot beds, the heel cup of his orthotic was unable to seat fully back. The result, a tight fit in the vamp and excessive heel slippage in the back. It didn’t matter whether the shoes heel counter was soft or firm, the orthotic would still not seat back.

    Worried that we still wouldn’t be able to shop, because it was increasingly apparent my husband wouldn’t be getting shoes, I thought AHA, I know, lets remove the custom orthotics and insert a pair of mens 3/4″ Superfeet instead.
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    Great for flats and slip on tennis shoes – Sticker – $19.95

    Within a minute of trying these beauties on with the Merrell’s – order was restored in the world. With a kiss and hug, my prince charming had found his slipper that fit. From then on he commented more than once on how he felt as though he was walking on a cloud.

    Thanks Nordstrom. Thanks Superfeet.

    F-Scan Findings: Atypical Heel and Arch Pain

    Three very similiar patients; one female and two male, having narrow, bony feet have all had chronic, longstanding arch and/or heel pain, accompanied by extreme plantar foot “sensitivity” and pain for many years.

    Each were on the brink of disaster alignment-wise, when a seemingly benign event (new orthotic, unexpected prolonged hiking) occured, changing them forever, sending them along a downward spiral of worsening, unrelenting foot pain. All have see countless foot specialists (podiatrist,orthopedists) and have tried a bundle of different shoes and orthotics with no success whatsoever. All have also presented with shoes that are too long and deep for their bony, skinny feet.

    As a board certified orthopedic podiatrist, I would have previously tried to cushion their orthotics or grind in a plantar fascial groove to offweight an otherwise tight, bow strung, plantar fascia. What I have learned instead, using F-Scan pressure mapping is that standard orthotic treatments don’t always work. Instead, fine tuning the trajectory parameter is essential to prevent excessive dorsiflexion of digits 2 or 3 during the toe-off phase of the gait cycle.

    Before and after results are listed below. Symptomatic relief using these principles in my three patients has not been immediate, but over 2-3 months time, all patients were 80% improved from before the study trial.