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