Monthly Archives: December 2007

When Heel and Ball of the Foot Pads Don’t Work

Whenever high heels walk into my office with the insides padded to the 9’s it’s almost guaranteed, that the shoe isn’t fitting properly. Possible causes:

  1. Shoe heel height is too steep and you’re sliding forward, losing arch support and contact.
  2. Shoe is too short and all of your body weight is crashing down onto the ball.
  3. Shoe is too deep in the toebox and you’re sliding forward
  4. Sides of shoe are too gappy and you’re not being held secure.
  5. You have a high arch and the instep of the shoe is below your arch’s instep.


This problem with this shoe was #5. In this case, heel and forefoot padding were insufficient to keep her foot in the shoe.


Squeaky Orthotics

If you have squeaky orthotics here’s an easy solution. Place cloth or duct tape on the underside of the orthotic as shown here.


The squeak occurs when the orthotic material springs on the shoe’s insole. Occasionally you will need to place the tape further back, but usually application as shown is sufficient to stop the squeak.

Heel Slippage: Foot Width, Foot Depth

Heel slippage generally happens when a shoe is too wide or too deep or both. Rarely do people think about depth when buying shoes. You can have a wide foot without much depth (flat foot), or you can have a wide foot with a lot of depth (high arch). Even if both feet are the same size and width, they wouldn’t be able to wear the same shoe.

Here’s an example of different depth shoes. The shoe on the left is shallow and the one on the right is deep, even though they are the same size and style.


If you experience heel slippage, then you probably need to look at shoes from the side as well as the top. Shallow feet need shallow uppers or they will slip in the heel.

Heel Slippage: Orthotics & Tennis Shoes

Whenever I dispense orthotics for the first time, I always re-lace a person’s tennis shoes. Without orthotics, your arch height is flatter than it is with orthotics.

By increasing the support undeneath your arch with an orthotic, you’re effectively raising your arch height, which in turn lowers the front part of your foot. If your shoe lacing doesn’t take into account this new foot shape, then you foot will act like a teeter-totter, popping your heel in and out of the shoe with each step.

Also, the best way to ensure proper fit is to completely cinch snug the laces closest to your toes and not the laces securing your foot to ankle. The more form fitting the shoe, the better the fit.

CNetTV & Me on Masai Barefoot Technology

I oftentimes am asked to comment on new shoe technology. Kara Tsuboi of CNet TV did a story on Masai Barefoot Technology (MBT’s) and interviewed me. Here’s a link to her video, where opinions, fact and fiction are explored.


My Masai Barefoot Technology review – MBT’s are heavy, wobbly, expensive and don’t work for every foot type (especially narrow) And, if you’re younger than 30, I doubt you would find them suitably fashionable to wear on your feet.

Arch Blisters – Flat Feet with Orthotics

If you have flat feet, wear orthotics and plan to do a lot of hiking (Grand Canyon), or downhill walking (Stairmaster), it’s important that your shoe be as supportive as possible in the instep.

This pair of hiking boots and running shoes were brought in for me to evaluate today, because they created blisters in the arch and JA didn’t know why.


A quick walk up and down the hall, and I had to turn my eyes away because of his extreme foot collapse. There was no support to hold up the arch at all.

Flimsy cloth or mesh on the inside of a shoe will always allow the foot to pronate (collapse). Mix in orthotics, a steep downhill or two and the skin friction produced against the orthotic because of excessive pronation, can hobble even the toughest of feet.

Pinch Callous Running Shoe Modifications

A pinch callous forms when there is friction against skin – usually the side of the big toe or or under the little toes. This is a patient’s healed pinch callous that formed during a marathon which I mostly shaved off.


This is the shoe which was used during the marathon. Notice the distinct red color, corresponding to the pinch callous bleeding into this runner’s sock and shoe? In this case the problem was the trim on the shoe, gouging into the pinch callous with each running step.


The cure?…a little surgery to excise the offending trim and voila! No more pressure, no more bleeding. The hole was made by this person’s foot, but cutting into the mesh would be fine too.


Narrow Feet Need A Narrow Outsole

If you have a narrow foot then you need to pay attention to the outsole width. A narrow foot typically needs a narrower outsole then a wide foot. Here are two medium shoe outsoles which illustrate the difference.


This person has a narrow foot and the shoe on the right was too wide (even though it’s a medium width) creating side to side motion in the shoe, resulting in plantar fasciitis and achilles tendonitis. Both of these conditions were non-existent in the narrower (also medium) shoe, pictured above on the left side.

Having a shoe that it too wide can be just as bad as a shoe that’s too narrow. Best to match the width of your foot to the width of the shoe.

Hammertoes & Full Length Insoles

Hammertoes are a condition where the toes draw up and the knuckles become prominent.


For many people with hammertoes, even a thin insole or orthotic can raise the toes up to the point where the toes rub and become raw against the inside toe box of the shoe.


This pair of Superfeet full length insoles are only 1/8″ thick under the toes, but even this slight elevation is enough to cause pressure in an already crowded toe box.

The solution? Trim the insoles to just beyond the ball of the foot, or just below the toes. Shortening the insole topcover length will provide the arch support without cramping the toes.

superfeet_sulcus_hammertoes.gif is really a great place to find shoes. I like them because they offer free shipping, no matter how many pair of shoes you buy. I like them because the shoes arrive fast. I like them because refunds are processed right away if the shoes don’t work out, and they have a 365 day return policy.
Mostly though, I like Zappos because they offer multiview.gif the grooviest feature ever, especially if you have a hard to fit foot. Here’s an example of how I use Multiview.

This patient has a wide, somewhat deep foot, with mild bunions. Her current shoes are Asics Gel Kayano. Although they are wide enough in the forefoot they were too narrow in the arch. Confident, I could find a better fitting shoe on, I started to compare other running shoes to the Asics using Multiview.

First I wanted a shoe with a wider outsole in the arch. As expected, I found several shoes which were wider than the Asics. The Etonic’s on the right, are just one example, the difference in width being immediately evident.


Next I wanted to compare depth. Again, the Etonic’s are much deeper than the Asics, which for this patient will provide a much better fit.

Comparing shoes using the Multiview feature can make the difference between perfect vs. not-so-perfect fit.

Running Shoe Lists – Aarghhh!

Someone came in today with a list of recommended running shoes. I hate running shoe lists. As well intended as they may be the ones I have seen are usually obsolete and tell only half the story.

Running shoe companies categorize their shoes as “Motion Control”, “Stability”, “Neutral” or “Cushioned”. Although these descriptions are useful when evaluating the lower (bottom half of shoe), they don’t take into account the upper (everything attached to the heel and sole).

Without matching both the lower and upper parts of the shoe to the upper and lower parts of your foot, you’ll wind up with a shoe that may work and then again may not.

If your a competitive runner or just enjoy a casual stroll – your foot deserves better.

Bunions – Running Shoe Must Haves

At least once a day, I treat someone having a bunion, wearing the worst possible running shoe. By worst possible, I don’t mean brand, because there’s no such thing as the perfect brand. What I mean is, design, or rather the shoe design features to look for in a shoe which will maximize wear ability and comfort.

For those of you with bunions, finding a running shoe that’s wide enough can be a frustrating challenge. Because of this, you oftentimes wind up buying a shoe that accommodates the bunion, but doesn’t fit the rest of your foot.

The better solution is to look for mesh over the bump and eyelets that extend to the bump or beyond. This way, the shoe is forgiving where your need it, without sacrificing proper fit in the rest of the foot. You can also skip the first pair of eyelets to instantly increase forefoot width as well.

Here is an example of what to look for.


Notice the mesh which pushes out where the bunion is? After doing this, if the shoe still feels snug, you can also skip the first set of eyelets to relieve even more pressure over the bump.

Heel Slippage: Blisters & Bloody Heels


How many of us excitedly wear our brand spankin’ new shoes for a special day or night out and we wind up with bloodied, painful heels because of the shoes?

If this is you, then chances are the shoe isn’t form fitting snugly enough which results in your foot moving up and down. Couple this friction with sweat and a stiff heel counter and you’ve created a recipe for pain.

Fortunately, here’s what you can do.

  1. Make sure your shoe fit snugs. Noticeable heel slippage in the shoe department will inevitably lead to blisters if the heel counter leather is stiff.
  2. If you’re prone to heel slippage (narrow or shallow feet), avoid any slip on styles that don’t adjust in the vamp, ie. straps, buckles and Velcro.
  3. If your heels still slip, use a tongue pad or custom cut out a tongue pad from Wiley’s Felt Remedy.

Now what if I’m too late and the blisters have already formed?

  1. Cut a generous square, with rounded corners of moleskin and completely cover the blister(s) so that it is visible above the counter of the shoe.
  2. Let the moleskin wear off on it’s own. Don’t pry off or the adhesive will take the top of the blister with it.
  3. Band-Aids aren’t big enough to help. You need t o custom cut the moleskin to ensure coverage.



Worn Outsole


This sole wear is shocking for two reasons:

  1. This is an expensive shoe, and should be re-soled when worn out.
  2. This shoe is too short. Central wear should always be at the ball and not forward from the ball, like this wear is.

Don’t let this happen to your shoe!

Men’s Dress Shoe Review – Narrow, Shallow Foot

Zappos. com is one of my favorite places for hard to fit feet. I especially like the multi-view feature to help evaluate a shoe’s width, depth and design.

Last week I picked out a dozen pair of men’s dress shoes for Jonathan, and today he showed up with a box of 7 pair to evaluate. All, were very handsome, but only the following two pair made the cut. An added bonus, they even worked with his bulky orthotics!

Even though Jonathan has a narrow foot, he could wear these shoes which came in a medium width, because of their shallow depth.

Johnston & Murphy – Bickel Panel Toe


Johnston & Murphy – Gosney Moc Toe Lace-Up


Narrow Foot, Wide Shoe – Telltale Lacing Signs

If you find that there’s little to no room between opposite eyelets when lacing your shoes, then your shoe’s probably too wide for your foot. Ditto if you can pinch folds of cloth between your first and second fingers in the toebox.


Conversely if your shoes upper when looking down, appears to be all shoelaces then your either have a really high arch, or your shoe is too narrow for your foot.


Shoe lacing patterns can tell you a lot about whether or not your shoe’s upper is the correct fit.

High Heels & Hills


If your foot slides forward (heel gapping above), while wearing high heels when walking on even a slight incline, 9 times out of 10, the balls of your feet will hurt. Trying to cushion or pad this forefoot area inside the shoe will only make it worse.

When wearing high heels, the shoe has to fit snug or you’ll slide. The best way to accomplish this is making sure your heel to ball matches the shoe’s heel to ball and if you slide, use Wiley’s felt remedy in the vamp and not a metatarsal pad.

If you slide, not only will the widest part of your foot move forward into the tapering toe, but you will also lose contact with the arch and your base of support. Ouch!

Best Time to Shop for Shoes

The best time to shop for new shoes is at the end of the day when your feet are their most swollen and sensitive to shoe fit. Here’s a picture of a shoe which is a) too tight and b) too tight. Notice the blanching around the throatline. Notice how the widest part of the forefoot is lopping over the outsole.

Rule of thumb…if a shoe feels or looks tight in the store (especially in the morning), it’s probably not going to fit later, unless you have a shoe stretcher. Bottom line, a fabulous shoe on sale, that’s too tight is no bargain…trust me, they’ll simply collect dust in the back of your closet.


Size Matters (Heel to Ball vs. Heel to Toe)

Almost everyone who comes into my office, gets their foot measured. Why? Because wearing the wrong size shoe can cause pain and most people have no idea what their foot size really is. When was the last time you had your foot measured? Do you know the difference between to heel to toe and heel to ball? You should…it’s important, and it can mean the difference between comfort and pain.

The following pictures illustrate these two different foot measurements. The first person’s foot measures a 13 (heel to ball) and the 2nd person’s foot measures a 7.5 (heel to toe). Some of us have a longer heel to ball measurement and some of us have a longer heel to toe measurement. Whichever measurement is longer (heel to toe or heel to ball), that’s what size you are.


Antique Shoe Buckle

Ever delightful Ann wore this beautiful brooch into the office today. Imagine my surprise, when she informed me, it’s actually an antique shoe buckle, fashioned into a pin. An heirloom from many years ago. Very intricate, very unusual, and very beautiful. Thanks Ann!