Category Archives: Foot Pain

Cycling Shoes – Bunions

If you have a bunion, finding a cycling shoe that’s wide enough can be a challenge, especially if the rest of your foot isn’t wide. One solution is to find a shoe with mesh over the bunion which will be more forgiving than leather or vinyl trim. The image below shows an older model Pearl Izumi shoe which had trim over the bunion, making the shoe too tight.

In this case, the simple solution was cutting away the trim in the area of the bunion, to expose the mesh. This allows for expansion of the forefoot without compromising the rest of the shoe fit.

Runners Toenails

Many people have a long 2nd toe. In runners, a long 2nd toe can cause repetitive trauma to the toenail, resulting in a thick, protruding toenail This happens especially when running down hills.

If you are a runner and your toenail looks thick like this, you will only make matters worse if you ignore it. Thick nails always have to be treated, otherwise your nails will become permanently deformed.

If your nails are thick, go straight to your nearest podiatrist and have them thinned. The procedure is painless and will make all the difference in appearance and comfort. Oh, and just in case you were wondering, the red in the above image is residual polish, not blood. The white appearing adjacent toenails have a surface type of fungus, primarily due to polish, and easily filed off.

Skating Boots – Modifications

This is the same roller derby boot as my earlier post.

These principles would work for any sport boot including hockey, figure skating and roller blading.

Although the modified lacing I previously blogged about helped, it wasn’t enough to alleviate all the outside of the foot pain, so I added permanent padding on the inside of the boot to off-weight the painful prominences and it worked like a charm.

Just because a boot isn’t custom, it doesn’t mean you can’t customize the fit. All you need is a creative shoe repair person and you should be fine.

Anatomy Of A Shoe – What You Don’t Know Can Hurt You

Important to the understanding of footwear and footwear function is the understanding of construction, or in this case – footwear anatomy. What follows is basic shoe anatomy. Instead of listing all parts of the shoe (welting, foxing etc), I have instead tried to convey a general overview, especially as it relates to the foot and more specifically, foot pain.

The anatomy of a shoe can easily be divided into two parts; the top 1/2 of the shoe is the Upper and the bottom 1/2 of the shoe is the Lower. These images show the main parts of the upper.

  • Toe Box – Area overlying the toes. Think of this area in terms of depth. The deeper the toe box, the more room your toes have. This is important if you have hammertoes or other top of the toe irritation or pain.
  • Vamp – This part of the shoe covers your arch. This section is a bridge between the toe box and the opening of the shoe or topline. You want the vamp of your shoe to fit snug. Too loose and heel slippage occurs, too tight and numbness in the toes can occur.
  • Counter – The back part of the upper which wraps around either side of the heel. The counter can be soft (collapsible) or stiff (non-collapsible). Stiff counters are usually better if your foot pronates a lot or your foot collapses immediately after heel strike.

The lower is what your foot rests on and includes the insole, shank, midsole, outsole and heel.

  • Insole – The insole is the foundation of the shoe. The upper is wrapped around the insole, the metal shank is riveted on the underside of the insole and outsoles, midsoles and heels are added as well.
  • In running shoes, this is oftentimes referred to as the lasting method. Cardboard lasted uses a cardboard insole, whereas slip-lasted uses cloth. A combination last combines both cardboard and cloth.
  • The softer the insole, the less torsional stability (lengthwise twist) the shoe will have. The firmer the insole (cardboard) the more structure and stability the shoe will have. Pronators or people whose feet collapse excessively, typically want a cardboard last.
  • Midsole and Outsole – Used to give a shoe more cushion and shock absorption. Running shoes almost always have a thick midsole. I’ve talked about EVA midsoles in other posts, suffice it to say the firmer the midsole, the stiffer and longer lasting the shoe. Soft midsoles on the other hand help with shock absorption, but wear out more quickly. Here are some related posts on running shoe midsoles

  • Sock Liner – Usually removable and rests on the insole. Many people confuse the sock liner with the insole. The sock liner serves a cushioning function, whereas the insole provides a structural one
If you are having foot pain, it will help to match your anatomy to your shoes anatomy or at least think about how a shoe is made, before you buy next time.

Body Language Interview – Head to Toe

My public radio interview went live today on You can hear the interview with show host Chris Springmann at – Show 5, Head To Toe, segment four, right after the vet interview. I would love to hear what you think!

Skating Pain – Bay Area Roller Derby Girls

Today, one of the Bay Area Roller Derby Girls (B.A.D.) came in having outside of the foot pain and swelling, primarily in her new boots. The pain was partially due to the motion of skating (push off) and partially due to boot forefoot compression and tightness because the outside of her foot was enlarged in this area.

A simple fix is to modify the laces. Whenever a shoe laces, you can always skip the eyelets to increase forefoot width as above. Here are some other posts where I blog about lacing modifications.

Modifications Part 2 can be found at:

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.

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


Many women who wear shoes that are too short develop hammertoes. This is a condition where the toes draw up, producing a buckling of the joints on the top of the toes.

Hammertoes typically occur more often in women having high arched feet as opposed to flat feet. Before you rush off to the surgeon though, have your feet measured and make sure your high heels are of proper length. Your toes will thank you.

Public Radio – Body Language Interview: 91.7 KAWL

Dear Readers,

In the next week I’ll be doing an interview, which will air in July, for Body Language, a new public radio show featuring contemporary attitudes towards health and wellness.

Part of what I’ll be doing is talking about the blog, including common shoe misconceptions as well as what it takes to keep your feet healthy and happy for years to come.

In preparation of the interview, I thought your input would be helpful, so I’d like to have you answer the following questions on the blog. If you would prefer to keep you’re answers anonymous, just let me know and I won’t post them.

  1. What’s the worst shoe advice you ever got?
  2. Are you a slave to comfort or fashion. Can you have both?
  3. How much money have you spent on shoes you can’t wear?

Thanks and if there is anything else shoe wise that you would like me to blog about, let me know, I love hearing from you!

Dr. Sanders

Shoe Cleats – Beware of Wear

If you play a sport which requires wearing cleats (soccer, baseball, football, golf) then you want check your cleat wear regularly.

Here’s a pair of turf soccer cleats, which are about a year old. As this image shows, the heel cleat on the right shoe is still flat, causing a pivot point and a protrusion force upward as compared to the heel cleat on the left shoe, which is evenly worn with the other cleats.

In this case, the cleat on the right shoe actually caused plantar fasciitis – heel pain, which could have been avoided if the shoes had been replaced before the cleats started to wear asymmetrically.

Shoe Review – Brooks Dyad for Wide Feet

I had a runner come it today with 3 different pair of running shoes.

The first pair were Brooks Adrenaline – which were much too narrow for her wide, deep foot. The next pair she tried were Saucony Pro Grid Omni which were better than the Adrenaline, but still too narrow in the waist (center arch) of the shoe. The shoes which fit the best are the Brooks Dyad, which as you can see, barely hourglass in.

Now look at the upper. Although both shoes are made by Brooks – they are different widths. The Dyad is wide, whereas the Adrenaline has a narrower upper.

When buying shoes, always check the outsole of your shoe, because just like Goldilocks, eventually, you’ll find an outsole which will be “just right”.

Excessive Outsole Wear

Running shoes are made shock absorptive by the use of ethyl vinyl acetate (EVA). Outsole EVA and midsole EVA can range from firm to soft. This shoe came it today where the firm EVA outsole wore through to the softer EVA outsole underneath.


Firm EVA on the outsole is a great way to prolong the life of shoe, however if applied thinly, it won’t withstand wear for very long.


Once you wear through into the soft EVA in the outsole, the structure of the heel will quickly deteriorate.

If you ever wear running shoes, be sure to monitor your shoes outsole wear.

Shoe Review – Asics GEL-Kayano

A marathon runner came in today with a worn pair of GEL-Kayano 12 and a new pair of GEL-Kayano 14. Even though both shoes were sized the same length and width, they were entirely different shoes.


First, look at the outsole. The newer version is on the left and the older version is on the right. There is more soft EVA in the worn outsole on the right, which would cause the forefoot padding of the shoe to break down sooner.

If you have a history of ball of the foot pain (capsulitis, sesamoiditis, metatarsalgia), you will want your outsole EVA to be as firm as possible, so the left model would be better for you.


Next look at the upper. See how the older Asics on the left is wider in the toebox and in the heel opening or throatline? In this case, if you have a wider foot or a higher arch, the older version would be a better fit for you.

All in all, even though the name is the same, the versions are not. Bottom line – these differing versions are entirely different shoes. Although both are shallow in toebox depth, version 12 will work best if you have a wide, shallow foot whereas version 14 will work better if you have a narrow, shallow foot.

Beware of version upgrades and check them carefully. Even if you shoe salesman swears up and down there is no difference, don’t take their word for it, make sure with your own eyes and hands it is indeed the same shoe.

Mizuno Wave Alchemy – Excessive Outsole Wear

A female runner came in today, who hasn’t been able to run for the past two weeks because of increasingly severe left ankle pain. She has been wearing a pair of Mizuno Wave Alchemy running shoes for the past 6 months and when I set the shoes on a flat table, this is what I found.


Notice how the back of the left shoe is tilted outward and the right shoe is more upright?

In this case, the shoes outsole is made of soft EVA (ethylene vinyl acetate), whereas this person should have hard EVA to support heel strike, especially on her left side. EVA is made soft by pumping in air, which is great for shock absorption, but accelerates outsole wear because of compression.

In this case, because the outsole compressed unevenly, this runner sustained significant peroneal tendon injury. At this point I’ve ordered an MRI to determine the extent of the tendon damage…A big price to pay for an excessively worn shoe.

This injury could have been completed avoided, had this runner known how to evaluate her running shoes. Lots of runners have rules when it comes to replacing shoes. The most common ones I hear are replace your shoes every 500 miles or every 6 months.

Unfortunately, because shoes vary so much in construction, an arbitrary rule can lead to injury. Instead, place your running shoes on a flat surface monthly and when they start to tilt, it’s time for a replacement pair.

Corns – Top of Toes

Here’s an image of a corn on the top of the 4th toe. You can imagine how painful this hard, dead skin can be.


If you get corns on the tops of your toes, you’ll want to check the depth of your shoes toebox. If you toebox is not tall enough, you need to find deeper shoes, or you can stretch your toebox to increase the depth.

Pinch Test – Slip On Shoes

Here is another image of a shoe that is too deep. Notice how much excess upper there is?


If your upper does not form fit to your foot then the shoe won’t stay on. It doesn’t matter if you use a tongue pad or wear really thick socks, the result will be the same. A sloppy, poor fit. You’re feet deserve better.

Top Of The Foot Bump

This image shows a bony prominence on the top of the foot. The medical name for this bump is exostosis. They develop more often in people having a high arched foot than people having a flat foot. They usually occur on both feet but can occur on just one. They are not worrisome at all, unless you wear shoes that strangulate your foot in this area.

This means no lacing directly over the bump in running shoes and no buckles or decorative trim over the bump, which are often found in loafer style shoes.


Here’s an easy way to modify your running shoes if you have an exostosis on the top of your foot. Unlace to where the exostosis is and then skip the eyelets that would otherwise criss-cross over the prominence. You shoe will still fit secure and this will alleviate pressure that would otherwise cause pain.


Additional posts about top of the foot bump, may be found here: