Category Archives: Shoe Fit

New Hiking Boots Causing Pain

Beloved patient and avid hiker, WR, came in today after completing a rigorous 80 mile, 6-Day hike in Morocco. Prior to the hike, he purchased new hiking boots, which coincided with his onset of pain and formation of a never-before-seen lump at the front of his ankle. Fortunately, ultrasound and MRI showed nothing seriously wrong in this area other than focal swelling and inflammation consistent with tendonitis.

After evaluating his new hiking boots however, it was apparent that the top hook-lacing combination was crossing at exactly the same point where his pain and swelling was. In short, due to where the laces were crossing, the boot was strangulating the tendon beneath this point.

The easiest solution was to skip the uppermost eyelet on his boot, which was causing the irritation as the following image shows.

Hiking_Boot_Hook_Irritation

If you or someone you know has a sudden onset of swelling or pain in the foot or ankle, seek treatment with your podiatrist right away. If nothing is found to be wrong, you may just need to modify your shoe lacing – or in this case hiking boots, to make the pain go away.

For other lacing tricks and applications, check out my other posts.

Lacing for Heel Slippage, Top of the Foot Bump and Bunions

Modified Shoe Lacing Soccer Cleats

Saucony Grid Stabil – Lock Lacing Design

Heel Slippage – Improper Shoe Lacing

Straight Lacing – Heel Slippage

Shoe Lacing – Narrow Feet & Hiking Boots

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.

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

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/

When Zero Drop Doesn’t Work

Zero drop minimalist shoes are all the rage right now. Unfortunately, just because a shoe has zero height differential — between the ball of the foot and heel — doesn’t mean it will work for you.

Case in point: One patient I saw today is an ultrarunner who switched from a structured shoe to a zero drop minimalist style two years ago to reduce unilateral infrapatellar pain. Fortunately, the pain resolved, but within the last several months he started to experience increasingly painful peroneal (outer foot) pain and medial (inner) meniscal knee pain. He did not have either pain prior to training in the zero drop shoes.

A quick evaluation of his zero drop shoes, identified an hourglass-shaped midsole/outsole.

Minimalist_Medial

The arrow shows the narrow midsole width and the rectangle shows how much of his midfoot was only being supported by the upper (25%). This significant lack of support mid-arch caused his arch to negatively drop below the plane of the heel and forefoot, altering his knee and foot mechanics enough to produce compensatory pain in other areas.

The following image shows the top view of his foot in the shoe. As you can see the grey midsole disappears from the entire arch — and this is where support is needed the most.

Minimalist_Hourglass_Medial

If you’re running in minimalist or zero drop shoes, you will still want to match the shoe to your foot type — otherwise new injuries can occur.

Cycling Shoe Brand Review – DZR

JC came in with a pair of DZR shoes today to be worn with his new custom orthotics, and I’ve got to say I’m impressed. Designed as an Urban Cycling Shoe, DZR is hip enough to wear even if you don’t cycle.

DZR_Top

DZR has the style of a skater shoe, without added forefoot flexibility — which is great for hallux limitus, sesamoiditis and metatarsalgia. For cycling, the outsole can be modified to accept Shimano SPD cleats for a clipless pedal ride, as the following video shows. Ingenious.

DZR_Bottom

Altra ZeroDrop Responds to Instinct Shoe Review

I previously posted a review on Altra Instinct and was contacted by AltraZeroDrop as follows:

“Interesting review. A couple of things as I consider what is being said here. First, The Instinct is a neutral shoe and is sold as such. The Brooks Adrenaline is a motion control shoe. To compare the two with a pronator is not a fair comparison. To look at an Altra shoe that offers some pronation support please check out The Provision. This runner obviously needs some medial support and thus The Instinct may not be the best option right off the bat. As they strengthen their feet over time maybe.”

My reviews are based on the shoes that runners wear in, and the Instinct is the only shoe I’ve seen from Altra. In this runner’s case, he purchased the Instinct based on it’s “wider,” more supportive appearance, only to develop forefoot pain.

Altra’s website promotes Altra zero-drop footwear as “reducing forefoot pain, excessive pronation, IT Band pain, runners knee and shin-splints.” These claims are made independent of Altra model or style, but are instead specific to the zero-drop platform. So, based on these general design claims, this particular shoe should have worked for this particular runner.

My primary goal for doing shoe reviews is to reduce injury by educating runners about their foot type and alignment, and teaching them how to apply this to their shoe purchases. I agree that runners need to match their foot type (pronated, wide, etc.) to their shoes and I’m pleased that Altra offers a stability model.

I have asked Altra to send me a pair for review. I’ll keep you posted.

 

Shoe Review – Altra Instinct™

I have had several runners in my office asking me to evaluate to evaluate their Altra™ running shoes. As much as I want to recommend this shoe, I just can’t. There are too many runners for whom the fit and structure of this shoe is incompatible, as the following video shows.

Shoe Review – Solomon XR Mission

A trail running shoe I like a lot. Features include a wide forefoot, firm heel counter, and torsional stability. Many running shoes that are wider in the forefoot are correspondingly wide in the midfoot and heel, but the Solomon XR Mission is not.

This XR Mission also has a firm, thick midsole,  which helps with shock absorption, as the following field review video shows.

Shoe Review – New Balance 813 Cross Trainer

New Balance 813 is a lightweight cross training shoe, as the following field review video shows.

I generally recommend a good running shoe for cross training — however, if you do not excessively pronate and need expandable forefoot volume, then this shoe might just work for you. New Balance 813 has minimal “hourglass” in the waist, is torsionally stable and has a firm heel counter which increases overall support.

Shoe Review – Mizuno Wave Creation 13

Mizuno Wave Creation 13 is a stable, well-structured shoe as the following field review video shows.

This shoe is torsionally stable, has a firm heel counter and an inflexible forefoot making it a perfect choice for those runners who excessively pronate. The generous use of mesh throughout the forefoot makes this shoe lightweight and forgiving where runners need it most.

The only problem with this shoe is it runs 1/2 size long based on heel-to-ball length with a correspondingly short toe box, so you will want to be careful when evaluating size. Other than that, Wave Creation 13 is a great shoe.

Shoe Review – Mizuno Wave Enigma

Mizuno Wave Enigma is categorized as a neutral running shoe, but has much more structure than a typical neutral shoe.

Important features include torsional stability and a firm heel counter, both of which help prevent excessive pronation. The forefoot is moderately flexible, but sufficiently cushioned to aid shock absorption. The waist of the Enigma is also wide and doesn’t “hourglass” in, making this one of my favorite Mizuno’s this season, as the following field review shows.

Shoe Review – Mizuno Wave Inspire 8

One of my least favorite shoes this season. Although Wave Inspire 8 provides great support and structure, it’s oddly narrow in the forefoot and wide in the rearfoot. This design makes Wave Inspire 8 incompatible with a normal foot type, as the following field research video highlights.

Shoe Review – Asics GT-2170

I previously reviewed Asics GT-2170 and compared it to Asics GT-2160. The following video is a field review of Asics GT-2170, which has changed significantly from Asics GT-2160. Although GT-2170 fits the same volume-wise as GT-2160, structure-wise, it no longer supports the excessively pronated foot.

Shoe Review – Mizuno® Wave Nirvana 8, Part 2

I’ve previously reviewed Mizuno® Wave Nirvana 8 but wanted to add my recent field review as well. Important note — this version runs approximately 1/2 size smaller than the listed size, so you will want to evaluate length when assessing fit.

I like this shoe, however, it won’t work for every foot type as the following field research shows.

Shoe Review – Brooks Ravenna 3, Part 2

I’ve previously reviewed Brooks Ravenna 3 but wanted to add my recent field review. Brooks Ravenna 3 provides a great fit for the rectangular foot. It’s lightweight and cushioned for the neutral runner who doesn’t pronate excessively.

Shoe Review – Saucony ProGrid Omni 11

ProGrid Omni has always been a solid shoe. For the past several versions, it has offered a rectangular shape and significant anti-pronation control — including a firm medial midsole, firm heel counter, and torsional stability.

Version 11, however, has reduced pronation control due to increased midsole cushioning (thickness) and less torsional stability.

This makes for a comfortable shoe with a trade-off in less durability and faster wear. In addition to the change from support to cushioning, the upper has also changed from a more fitted style to a more boxy style with a deeper toe-box. For some runners, this may predispose them to a less secure fit than previous models as the following field research shows.

Other ProGrid Omni Reviews:

https://drshoereviews.com/2009/11/09/shoe-review-saucony-progrid-omni-8/

https://drshoereviews.com/2008/07/16/shoe-review-saucony-progrid-omni-6-ultimate/

Shoe Review – Brooks Adrenaline GTX Trail Running Shoe

Brooks has done it again, with the introduction  of the Adrenaline GTX, all terrain, trail shoe.

Adrenaline GTX is more rugged than Adrenaline ASR due to the Gore-Tex, waterproof, upper membrane. This shoe is also extremely stable, which is especially helpful during muddy or wet running conditions.

Additional features are highlighted in the following video.

Shoe Review – Asics Gel Foundation 10

Asics Gel Foundation 10 is similar to version 9 in that it is highly structured and torsionally stable, with a firm heel counter and an inflexible forefoot.

The differences between version 10 and version 9 have to do with volume. Version 9 was available in narrow, whereas version 10 isn’t. Version 9 was also more shallow than version 10 which will affect those runners who choose this shoe based on volume.

For all other runners, as the following video shows — this remains a great shoe.