Category Archives: Foot Pain

I have had several runners and one roller derby player come to the office recently having sesamoiditis. The sesamoids are two small bones which are embedded in the tendon directly underneath the big toe joint. They act as a stabilizer of the big toe, keeping the toe moving up and down as opposed to side to side.

Sesamoids can occasionally fracture or be bipartate. Bipartate means that an individual sesamoid which normally starts out as two pieces and fuses together doesn’t fuse, leaving the two pieces separate, which the image below shows.

High-arched feet have a greater tendency to develop sesamoiditis than flat feet. Excessively worn, poor fitting or improperly designed shoes can also cause sesamoiditis.

Medical treatment depends on the severity of pain include icing, anti-inflammatory medications (Advil/Aleve), cortisone injections into the joint, immobilization and orthotics.

Shoe treatments include wearing a shoe that doesn’t flex at the forefoot or have a thin, non-shock absorptive sole. In a running shoe, this means no flex groove directly under the big toe joint where the sesamoid is inflammed.

Going barefoot is also not a good idea until the area heals.

Since the sesamoids bear weight with every step, this condition can take several weeks to months to improve. If however, the pain remains unchanged in spite of the treatment, then MRI should be used to make sure there’s no fracture. Fractured sesamoids require non-weight bearing immobilization with cast and crutches and occasionally surgical removal of the sesamoid.

If you have pain under the big toe joint that doesn’t improve with reduced activity and rest then you may have a fracture. Whether or not you have big toe discomfort of pain, it’s important to see a podiatrist for evaluation. Waiting to seek treatment can make this condition worse.

Horizontal grooves in the forefoot of running shoe outsoles are called flex grooves. As the name implies, flex grooves are designed to promote forefoot flexion across the ball of the foot.

In many cases of forefoot pain, however, this is exactly where you don’t want the shoe to bend. You actually want the shoe to be as inflexible as possible in this area if you have the following forefoot conditions: hallux limitus, sesamoiditis and metatarsalgia.

If you have forefoot pain, deep flex grooves located directly beneath the affected joint will cause an increase in forefoot flexion as well as reduced shock absorption due to a lack of an overlying outsole in the area of a groove.

The shoe on the left side of the image has flex grooves adjacent to where the forefoot bends, which can alleviate forefoot pain. The shoe on the right side of the image has a flex groove where the forefoot bends, leading to more pressure in this area.

If you experience pain in the forefoot, check the flex groove placement in your shoes. Flex grooves in the wrong place can contribute to forefoot pain.

My area of expertise, aside from shoes of course, is biomechanics. I received specialized training in podiatric orthopedics and in orthotic evaluation and treatment. If you are considering custom orthotics, or if they have been recommended to you, you will want to make sure a thorough evaluation is done.

This video, although longer than my earlier videos, provides comprehensive information about how the custom orthotic process works in my sports medicine clinic. Understanding this process will make you a more informed consumer, and hopefully guide you to someone who is equally qualified to do this most important rehabilitation step.

Although many specialists make orthotics (chiropractors, physical therapists, and pedorthists, to name a few) they just don’t have the knowledge or training to be able to do this as well as a qualified sports medicine podiatrist – see www.aapsm.org for more. So it’s worth your time to not only find the best shoes, but to also to find the best provider of custom orthotics if they are prescribed for you.

Hallux limitus and hallux rigidus or turf toe are painful conditions of the big toe joint. Recently, my associate and FDFAC surgeon Dr. Sandi Pollard did a video about these injuries that I wanted to share.

Here are my other blog posts about hallux limitus, hallux rigidus and turf toe.

https://drshoe.wordpress.com/2008/10/30/hallux-limitus-vs-hallux-rigidus/

https://drshoe.wordpress.com/2008/01/08/shoe-design-for-hallux-limitus-ie-turf-toe-non-bunion-pain/

Rocktape is a company that makes a comfortable, long lasting, easy-to-use sport tape which can enhance athletic performance as well as help recover from injury. I am a huge fan of Rocktape and prescribe it for many of my patients. Rocktape has extensive how to use instructions on their website. The following videos show taping methods I developed using Rocktape for plantar fasciitis and posterior tibial tendonitis.

Superfeet are my favorite non-custom insoles. They come in a wide variety of styles for many different shoes. What most people don’t realize is that even though Superfeet are pre-sized A,B,C,D etc. your foot may not fall exactly within the corresponding numbered size. This video shows you how to properly size Superfeet so that you get optimum support. My other posts about Superfeet follow the video.

https://drshoe.wordpress.com/2007/12/18/hammertoes-full-length-insoles/

https://drshoe.wordpress.com/2008/07/29/spin-class-arch-pain/

https://drshoe.wordpress.com/2008/01/22/dress-shoe-orthotics/

Wearing the wrong shoes can directly cause or contribute to plantar fasciitis and Achilles tendonitis. Especially shoes that are excessively worn https://drshoe.wordpress.com/2011/10/23/how-to-tell-when-your-athletic-shoes-are-worn-out/ or are the wrong size.

If you have already replaced your shoes, what else can you do? Achilles tendon stretches, that’s what. When the Achilles tendon is tight the foot compensates by pronating and pronation directly contributes to both Achilles tightness and plantar fasciitis.

Muscles attach tendons to bone and in this case, these two muscles join to form a common tendon, the Achilles. In this video, Whitney will show you how to stretch the Gastrocnemius and Soleus muscles. Performing these individual stretches daily in addition to wearing the right shoes, should get you back on track no time.

If the pain persists however, make an appointment with your nearest Sports Medicine Podiatrist for additional evaluation and treatment.

Reader Jason asks “I was wondering if you had more information about shin pain during running.  what could be the cause, what could be the remedy, etc.? “

Shin splints also known as Anterior Tibial Tendonitis can occur for a variety of reasons.

Here are the most common causes I see in my office.

• Shoes – A soft lateral midsole or simply excessive wear can cause shin splints. If you haven’t had shin splints before  and then you do, you probably need new shoes. If the wear looks like this (especially the left) when you set your shoes on a flat surface, then excessive wear is probably the cause.

• Over-training or changing running surface or terrain. A change to concrete from trails or an increase in downhill running can also cause shin splints.

• Alignment – A condition called tibial varum (bowed legs) can predispose a person to shin splints as this causes the pull of the muscle to be angled versus straight, resulting in the muscle pulling away from the lower leg bone (tibia). If a person’s tibial varum is significant, it can also cause Achilles tendonitis or even a stress fracture of the tibia which becomes a serious problems activity-wise.

Whenever I have a patient with shin splints, I do a thorough treadmill evaluation with shoes on and off and make specific recommendations if the problem is the shoe. I will also do a complete medical examination including xrays, ultrasound and MRI if indicated.

If the problem is biomechanical (alignment)I will make a custom orthotic, especially if the pain has been long standing. If the problem is acute I will try taping, icing and over the counter anti-inflammatory medications (Motrin, Aleve). If this doesn’t work and the pain is really severe, I will probably do a cortisone injection, which typically works very well.

If the problem is over-training I have the person back it up and if it’s a change in terrain, I’ll recommend softer trails and/or fewer hills until the pain lets up. Physical therapy can also help.

Many patient’s I see have arch or heel pain, otherwise known as plantar fasciitis. The plantar fascia is a structure on the bottom of the foot which extends from the heel to the ball of the foot. When it is tight (bow-strung) it can cause inflammation and pain.

Not surprisingly, shoes can cause plantar fasciitis, especially shoes that are excessively worn, too short in the arch or too flexible. If you have plantar fasciitis you will definitely want to evaluate your shoes. You should also try not going barefoot in the house.

If the pain persists, you will want to visit your podiatrist who may recommend calf stretches, anti-inflammatory medications (Motrin, Aleve) or give you a cortisone injection. Custom orthotics may also help. If you have morning pain, your podiatrist may want to fit you for a night splint which will keep your plantar fascia stretched out all night or show you how to tape if the pain persists.

Although plantar fasciitis is a common condition, the longer you wait to seek treatment, the harder it will be to resolve.