Category Archives: Foot Pain

Cycling Shoes And Sesamoid Pain

Sesamoiditis is inflammation of the bones beneath the big toe joint.

Cycling can exacerbate sesamoiditis, especially when using clipless pedals (this is because your forefoot is locked in). This system provides a more efficient stroke for bikers, but if the cleat is in the wrong place or the last (shape) of the cycling shoe is different than the riders foot, then repetitive injury can occur

Sesamoiditis

This was the case with Lisa. She had been happily riding in the same version of a particular cycling shoe for years, and a change in shoe brought about symptoms of sesamoiditis.

Evaluation of her new shoe revealed that the cleat was positioned too medial (toward the midline). Note the difference between her old shoe (on the left), and her new shoe (on the right).

Image

I also discovered that the shape of her new cycling shoe was curve-lasted, whereas the shape of her old cycling shoe was straight-lasted. (And the straight-lasted design was far more compatible with her foot shape.)

Image

This combination of medial cleat placement and change in shoe last from straight to curved contributed to her painful symptoms of sesamoiditis.

If you are a cyclist who has recently experienced injury, it would be beneficial for you to evaluate your cycling shoes and cleat placement. This is especially true if new symptoms arise soon after wearing new cycling shoes, or after increasing your training frequency, duration, or intensity.

Sesamoiditis can be a challenging problem to resolve, so it’s important to seek immediate medical attention at the first sign of injury or symptoms.

The physicians and surgeons at San Francisco’s Financial District Foot & Ankle Center are experts in treating sesamoiditis, and in treating lower extremity cycling injuries in general. If you have cycling pain, give us a call today at (415) 956-2884.

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Spin Class and Forefoot (Sesamoid) Pain

Reader Mary makes a good point of caution:

“I love spin cycling and wore mountain bike cycling shoes in class. I fractured my right sesamoid bone in my foot. I did not clip in–just used the cages. I haven’t been able to go back to spin cycling since the injury.”

Sesamoiditis is a common condition where one of the two bones underneath the big toe become inflamed, injured or fractured. This most commonly occurs when there is repeated, constant pressure or force applied to the sesamoids or during a one-time time traumatic event.

This image shows the anatomy of the sesamoids as they relate to the big toe joint.

Sesamoid_Anatomy

This image is of a weight-bearing x-ray, showing an intact sesamoid next to a fractured sesamoid.

Sesamoiditis

I have treated many cases of sesamoiditis and fracture that happened during spin classes. Typically, this happens when the pedal rests squarely below the forefoot or when the majority of the class is spent out of the saddle.

You may need an MRI to confirm that the fracture is healed before going back, and you will definitely need to modify your cycling form. Less standing and less resistance when you do stand will give your quads more of a workout, and will also reduce the force going through the sesamoids.

For more information regarding sesamoiditis, here’s another blog post I wrote https://drshoereviews.com/2012/01/25/sesamoiditis-2/

Cycling Shoes and Bunions

Clipless cycling shoes are notoriously tight. This is great for fit, and not so great if you have a wide forefoot or bunions. If you are a cyclist and suffer from bunions or have a wide forefoot, the following shoe-fitting recommendations should help.

Cycling_Bunion

  1. If possible, try and find shoes that don’t have a strap that tightens over the bump as seen above. Ideally, you will want to wear shoes that have either 3 straps or an offset strap away from the bump as this image shows.

Cycling_3_Straps

  1. If you already have a shoe that secures and tightens directly over the bump, simply undo the strap and avoid using it entirely as the following image shows.

Cycling_Bunions_Unsecured_Strap

Non-Slip Work Shoes for Narrow Feet

If you need a non-slip shoe for restaurant or housekeeping work and you have a narrow foot, your choices are very limited. Fortunately, Skechers makes a non-slip lace shoe for men that — even though sized medium — runs narrow. The style is called Rockland-Systemic and can be purchased from Zappos.com.

First and foremost, this shoe is great because it laces (as opposed to being a slip-on style), which is always better for the narrow foot. Also terrific is the fact that there are 6 sets of eyelets: the more eyelets there are, the better the shoe fit, especially for a narrow foot.

Skechers_Rockland_Work

Finally, there is no hourglass in the waist of the shoe, which provides support in the arch where needed most. This also makes for a stable foundation if orthotics are to be worn inside the shoe.

Skechers_Rockland_Waist

Hiking Boots & Bunions

Hiking boots are designed to resist side-to-side motion. This is typically accomplished by using a stiff upper and reinforcing the shoe both laterally and medially. Although this is great for support, it can make the shoe feel like a vice grip for those hikers having bunions or needing extra forefoot width. If you have bunions, then you will want to make sure your shoe doesn’t have additional trim over the bony prominence.

Hiker with Tailor's Bunion with hiking boot trim removed over painful area.

Hiker with Tailor’s Bunion with hiking boot trim removed over painful area.

If it does, then removing the trim can mean the difference between comfort and pain. The following image is a hiker having a Tailor’s bunion. As the image above shows, it was easy to remove the trim, making the boot more forgiving in those otherwise tight areas.

You can also modify the lacing as the last tutorial in the following video shows.

Waist Not, Want Not

The mid-arch portion of a shoe is called a waist. In general, the waist of a shoe should hourglass only minimally. The following image shows a Puma shoe with a waist that is ridiculously narrow – even for an average width foot.

Waist_Hourglass

If you excessively pronate, or have any conditions associated with excessive pronation (plantar fasciitis, posterior tibial tendonitis, Achilles tendonitis), then wearing a shoe lacking support in the waist (midfoot) could prevent you from getting better.

Next time you find yourself shoe shopping, in addition to checking the price tag on the sole of the shoe, also check the width of the waist. Having a wide waist is good for shoes, bad for cardiovascular health.

Worn Out Shoes Are Just As Dangerous As Bald Tires

I am always amazed – but not surprised – when a patient comes in with foot pain that won’t go away due to worn out shoes. Yes, I know we all get busy. Yes, I know shoes can be expensive. However, let me point out that a typical visit to your doctor will probably cost a lot more than buying new shoes.

This patient experienced increasing posterior tibial (instep) pain for more than three months. She regularly does a considerable amount of city/pavement walking, and it never occurred to her that her worn out shoes were contributing to the problem.

Supernova_Outsole_Wear
Side-by-side images of the worn shoe and a new shoe illustrate the severity of wear. Similar to tire treads, the outsole of a shoe is designed to prolong wear and protect the less durable midsole. Once the outsole is worn through, the midsole breaks down, changing the way the foot strikes the ground.

This image is of a patient who sought treatment for a painful callous on her forefoot.

Worn_Shoe_Forefoot_Callous

Evaluation of this patient’s shoes showed not only excessive forefoot and rearfoot outsole wear, but actual splitting of the forefoot outsole/midsole. This caused increased weight bearing across the forefoot, and pinpoint callous build up due to the lack of shock absorption and shoe protection in this area.

Worn_Shoe_Forefoot_Rearfoot

If your shoes are worn, it’s important to replace them. If you’re not sure if your shoes are excessively worn, review my other posts on monitoring and evaluating shoe wear. This is too important to ignore.

https://drshoereviews.com/2011/10/23/how-to-tell-when-your-athletic-shoes-are-worn-out/

https://drshoereviews.com/2013/06/30/evaluating-athletic-shoes-for-wear/