Monthly Archives: July 2008

Spin Class – Arch Pain

Reader Pete asks “I have been in a spin class for 8 months. Recently I have developed chronic right arch foot pain to the point that it’s difficult to walk for several days after class. I have severe flat feet that pronate inward-no arch at all. I am cycling with cage on pedal. Would cleats be better for the foot pain? The problem is worse when standing or climbing.”

Sounds like you’re getting plantar fasciitis (arch or heel pain). Your flat feet are most likely the cause. As long As long as you have stiff soled cycling shoes, it shouldn’t matter whether you use cages or cleats. As for the pronation, you might want to try a non-custom orthotic and see if this helps. Superfeet are good, and they make a cycling specific insoles (new yellow below). 

Have you been to a podiatrist? If not, you should see one. He or she should be able to get you back on track (stretches, physical therapy, taping, custom orthotics) in no time.

Heel Taps – Spend A Little Save A Lot

Here’s an example of a heel tap on a shoe.

Commonly made out of plastic or rubber, heel taps help prolong the life of your heeled shoes. Normal heel wear is on the outside so the taps should be placed here. Considering a pair of taps cost less than $10 and re-soling a pair of heels can run as much as $50, taps are a good value and easily applied. The plastic taps aren’t as durable as the rubber ones, so if your shoe repair person carries rubber taps, you’ll be better off.

Top of The Foot Bump – Part 2

Reader Kevin asks “I have a soft tissue swelling (with pain) on the top of my left foot, beneath my ankle and toward my pinky toe. Can’t find any information on it. Any suggestions would be appreciated.”

My suggestion would be a ganglion. A ganglion is usually an out pocketing of a joint including fluid (think balloon), which creates a soft mass in the skin which can enlarge and shrink, depending on the overlying irritation. It’s usually non-tender but can become painful, especially if it enlarges with fluid and there is pressure from a shoe rubbing against it.

This image shows a mild ganglion on the outside of the foot. Ganglions can also occur in the wrists, and legend has it that bibles were used to smack the area as hard as possible to disperse the fluid within the sack. I prefer to use a syringe.

If that doesn’t work, then surgical excision is sometimes necessary as this video shows:

If you have an unusual swelling under the skin on your feet, you will want to have it evaluated by a podiatrist in your area.

For another cause of top of the foot bump see my related post


Callous Is Not Your Friend

At least once a day a runner comes in with callous and blood blisters which have formed because of the callous burrowing into the skin. Time and again, I’m told that the person has been instructed not to remove the callous as it is protective in nature. Not true. Although callous initially builds to cushion and protect, eventually it becomes an irritant causing more harm than good.

The above images are of runners whose callouses have become blood blisters. If you have callous, either file it off or seek treatment with a Podiatrist to do it for you. Your feet will thank you.

Bunions – Increased Forefoot Width

Here’s an image of a bunion which shows what the condition looks like on x-ray from two different views.

A bunion is a drift of the bones about the great toe joint. As you can see from the above images two things generally happen with a bunion:

  1. There is an increase in the angle between the the first and second metatarsals (long bones)
  2. There is a drift of the big toe toward the 2nd toe.

The net effect is an enlargement of the big toe joint on the inside of your foot and a widening of the forefoot in this area.

Bunions can make shoe fitting especially challenging. Things to consider are soft materials over the bump like mesh or weave materials. You will also want to avoid stitching or decorative trim over the bump. And finally, shoe stretchers can also help, see my post

Shoe Of The Month – Ash® Patent Leather Ribbon Lace

This is a beautiful and well designed shoe. Unfortunately, you won’t be able to find it anywhere online, as I just checked. It does however have some great features which are worthwhile to search for when buying a pair of high heels.

  1. The ribbon tie is adjustable accommodating different foot depths.
  2. The toe box is wide and rectangular which won’t pinch the toes.
  3. The heel comes straight down from the back of the shoe vs. offset, i.e. kitten style.
  4. The heel is 3″ which will work for most women.

The reason I don’t do many reviews on women’s shoes is because, whenever someone brings in a blog worthy pair, by the time they get to me the style has been discontinued. I therefore try and show you the design of shoes and what to look for.

Shoe Review – Saucony Progrid Omni 6 Ultimate

This shoe has a lot of mesh in the forefoot upper, which can help if you have hammertoes and /or bunions. The back of this shoe has a firm heel counter, which helps guide heel strike if you pronate excessively. This shoe also has firm EVA (ethyl vinyl acetate) in the midsole extending from the arch to the back of the shoe which makes it very stable.

A general rule of thumb is the darker (more grey) the outsole, the more firm or less flexible the shoe will be. This design feature helps those feet who need lots of support, especially at the rearfoot. The difference between the Ultimate and the Moderate version is the Ultimate has EVA which wraps around to the heel wheras the Moderate just has EVA in the instep.

The mens and womens version of this shoe come in medium and wide but not extra-wide and the toe-box is not too deep which can help fit considerably if your foot is wide and shallow.

Version 7 has just been released and from what I can see on, it looks to be essentially the same as version 6, but I’ll keep you posted if that changes. The other good news is, because version 6 is being upgraded, you can probably find this shoe on sale. At Sports Basement in San Francisco, this shoe is marked down from $100 to $64. Quite a deal for a well made shoe!

Shoe Review – Nike Air Pegasus Trail Shoe

D.M. came in today with his barely worn Nike Air Pegasus Trail shoes. He was recovering from a fractured sesamoid bone (small bone under the big toe joint) and wanted me to evaluate his shoes before he resumed running.

He had purchased the running shoes prior to his injury and spent over two hours in a specialty running shoe store, trying on every shoe in the store, because of his difficult to fit narrow foot. Finally, with the help of the sales staff, he found this Nike Air Pegasus Trail shoe. It was apparently rated highly by a runners magazine, which helped to close the sale.

The above image shows the shoe which on first glance appears moderately deep and wide, but I was keeping my fingers crossed, at least until I saw D.M. stand in the shoes.

Normally, the back area of the shoe (heel counter) should be perpendicular to the standing surface. As this image shows, the heels are turned out, which is not good for healing sesamoids, knees or alignment in general. No wonder he wasn’t getting better.

Moral of the story. Just because someone says shoe xy or z is the best shoe ever, make sure the shoe works for your foot and not someone elses. It could me the difference between healing and continued pain.

Shoe Review – Adidas 7406 Soccer Cleats

Finding a wide shoe for soccer is no simple task. Most soccer shoes fit painfully snug, so if your foot is outside of the bell shaped curve, trouble may loom ahead. I found this shoe for someone having serious ingrown nails, because of the narrow toebox fit. Luckily I found the Adidas 7406 which have a couple of great features and fit him perfectly.

  • The eyelets extend beyond the ball of the foot, closer to the toes. This allows for width adjustability. Many soccer cleats don’t lace down this far and if your foot is wide, this can really help.

  • The arch width doesn’t hourglass in like most soccer cleats, given the arch full support as seen below.

And the overall width is slightly wider than most other soccer shoes and has a removable sock line which will accommodate an orthotic if you need one.

Saucony Grid Stabil – Lock Lacing Design

Saucony Grid Stabil has incorporated lock lacing into their design. It requires longer laces and if you don’t know how to cinch up the excess laces using this method, you could just trip and fall. 

When you look at the eyelets from the side, lace through all of them just like this image shows.

Now, instead of making the bow on the inside, take the end of each lace and thread through the loop on the opposite side. 

Finally, cinch tight pulling the laces horizontally from side to side. This method of lacing will stay tight until otherwise loosened. The only down side… it takes more time to tie and untie and if you don’t have a problem with heel slippage, then you have excess lace length for no reason at all.

Shoe Review – Saucony Grid Stabil

Saucony Grid Stabil is one of my favorite shoes and I recommend it at least once a day for the narrow (rectangular) foot. Surprisingly it works for shallow (flat) and deep (high arched) feet, because it comes in both medium and wide widths. For a refresher on foot width determination, refer to my blog posting

As for the construction, this is one of the few running shoes which is proportional, meaning the heel to ball and heel to toe measurements are true to size ( It’s also deep enough to accommodate a sport orthotic once you remove the sock liner.

It has a non-collapsible heel counter which helps guide heel strike and it has a firm inside mid-sole (grey above) which helps with pronation or foot collapse. Lastly the toe box is shallow meaning it will pass the pinch test (, providing a secure fit, if your foot is lower volume than most.

Ten Tips To Foil A Flip-Flop Fiasco – American Podiatric Medical Association

Thanks to surgical resident Rachel for forwarding the American Podiatric Medical Association’s (APMA) “Ten Tips To Foil A Flip-Flop Fiasco”. My comments follow in italics.

Flip-Flop Do’s:

  • Do look for a flip-flop that is made of high-quality, soft leather. This material, unlike plastic or foam, will minimize the potential for blisters and other kinds of irritation. I don’t agree with this one, as there are lots of high quality flip flops that are not leather. Also, leather can stretch, causing the flip-flop to become loose over time.
  • Do look for flip-flops that hold APMA’s Seal of Acceptance, such as Chaco’ Flip Collection and Wolky’s Serenity, part of their Zen Collection. Evaluated by a committee of APMA podiatric physicians, these products are shown to allow for the most normal foot function and promote quality foot health. I think Chaco’s and Wolky’s are well made sandals, but they won’t work for every foot. Here’s my blog posting with my thoughts on running shoe lists. I also think there are a lot more sandals than just Chaco’s or Wolky’s which allow for normal foot function.
  • Do gently bend the flip-flop from end to end, ensuring that it bends naturally at the ball of the foot. Shoes should never fold in half. Wise advice indeed.
  • Do wear a sturdy pair of flip-flops when walking around a public pool, at the beach, in hotel rooms in locker room areas. Walking barefoot can expose foot soles to plantar warts and athlete’s foot. If your flip flops are rubber, it’s a good idea to occasionally mist the wearing surface with Lysol Disinfectant Spray, to kill any harmful organisms which might hover on the top of the shoe.
  • Do ensure that your foot doesn’t hang off of the edge of the flip-flop.

Flip-Flop Dont’s:

  • Don’t re-wear flip-flops year after year. Thoroughly inspect older flip-flops for wear. If they show signs of severe wear in the soles, it’s time to discard them. Set them on a table to evaluate the heels. If flip-flop flops to one side, they need to be replaced.
  • Don’t ignore irritation between toes, where the to thong fits – this can lead to blisters and even worse irritation. Ditto for where the side straps insert into the flip-flops. If callous forms here or anywhere else on your foot because of the flip-flops, then it’s time to say goodbye to the flip-flops and get a new pair.
  • Don’t wear flip-flops while walking long distances. Even the sturdiest flip-flop offers little in terms of shock absorption and arch support. Gotta love common sense!
  • Don’t do yard work while wearing flip-flips. Always wear a shoe that fully protects the foot when doing outside activities like mowing the lawn or using a weed-eater. According to the Annuls of Emergency Medicine – Researchers analyzed emergency room and hospital records from 1996 to 2004 and found that nearly 663,400 people went to the emergency room and almost 12,000 people were hospitalized in lawn mower accidents during that period. Yikes
  • Don’t ever play sports in flip-flops. You can easily twist your foot or ankle, leading to sprains or breaks. More good advice.

Shoe Review – Pikolinos Romana 8809

Pikolinos is a Spanish company which has been around since 1984. Because they are imported, their price is higher than a lot of US brands, but Pikolinos are well made using quality materials which helps.

Someone came in today having a bunion, wearing the above shoe. Notice how the flowers on the upper are actually cut-outs? This is a great design and many Pikolinos have similar styling. This open weave eases tightness over protruding bunions or hammertoes, making it a very foot friendly fit. The only problem with this particular style is it won’t fit a really wide foot. 

Other styles can be found at Pikolinos website