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.

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

Help Texas! Donate your Shoes Today!!

This just in from our friends at Fleet Feet…

As part of a coordinated relief effort, Fleet Feet Sports stores across the country are now accepting donations of new or gently-used running shoes and new socks to send to our stores in Texas. Fleet Feet Sports of Greater Houston and Fleet Feet Sports San Antonio will work to get these shoes and socks to organizations and people in need. Our thoughts remain with the people, communities, and businesses affected by Hurricane Harvey and the flooding taking place in its aftermath. #shoesforhouston

If you live anywhere near one of the countries 170 Fleet Feet stores, run, don’t walk and get your shoe and sock donations to one of their stores today.

Post the above on Facebook, Twitter and your Instagram feeds. The more people who know about this, the more people in dire need can be helped.

With deep gratitude.

Dr. Jenny Sanders

 

 

Night Splint for Plantar Fasciitis

Plantar fasciitis is one of the most common conditions we treat in our sports medicine clinic. Inflammation of the plantar fascia causes pain in the heel or the arch.

A hallmark of plantar fasciitis, is pain when you first step out of bed in the morning. If  your first step in the morning is a pain in your heel or arch, you may want to try a plantar fascial night splint.

Plantar Fasciitis Posterior Night Splint – Medium (Colors May Vary)

A plantar fascial night splint is designed to keep your foot at a 90° angle, which gently and continuously stretches the plantar fascia, minimizing contraction, that can cause morning pain.

In our clinic, we recommend patients wear the night splint three hours before going to bed, which is usually effective in eliminating their morning pain. If your pain is not alleviated with wearing the splint before you go to bed, then wear it to bed.

Here’s a video from our FDFAC YouTube channel showing you how to properly use your night splint.

If you think you have plantar fasciitis or some other similar condition, it’s important to seek treatment with your podiatrist, as a delay in treatment may make your condition worse.

Life happens. Don’t wait.

A Cycling Shoe for Wide Feet

Cycling shoes are notoriously narrow, which is why cyclist with wide feet can have such a hard time finding cycling shoes that fit. TC came in today wearing a new pair of fi’zi:k cycling shoes whose fit he wanted me to approve, to which I immediately did. His model, R5B Uomo Boa, was a perfect fit for his wide feet.

Surprisingly, I had never heard of the fi’zi:k brand before, but their description impressed me as much as their shoes did. I found the following information on their website:

Fizik: Born in 1996 as a brand made for high performance fi’zi:k was designed in the USA, and handmade in Italy by the world’s largest saddle manufacturer, Selle Royal. Fi’zi:k is the phonetic spelling of the word physique, referring to the form or state of the human body.

If you have wide feet and are at a loss for a well-designed, well-made cycling shoe, check out fi’zi:k. Several specialty cycling stores carry this brand as does Amazon.com.Fizik R5B Uomo Boa, Black/Dark Grey Although this model is sized medium, it runs wide.

With an MSRP of approximately $150, this is definitely one shoe you will want to try on if you have wide feet.

Stay tuned for my next cycling post where I’ll be discussing the top 5 most common cycling foot injuries I treat. In the meantime here’s a link to some of my previous cycling posts:

Cycling Shoes And Sesamoid Pain

Spin Class and Forefoot (Sesamoid) Pain

Cycling Shoes and Bunions

Cycling Shoe Brand Review – DZR

Life happens. Don’t wait.

Big Toe (Pinch) Callus

At least once a week I treat a runner with painful calluses under one or both big toes. This type of callus is known as a pinch callus and typically goes unnoticed until it gets so thick a blister forms underneath it, or causes pain due to lack of cushioning from the running shoe.

Removing the pinch callus alleviates the pain, however understanding the cause is key to preventing a recurrence.

Today, a runner came in having a pinch callus and didn’t realize the cause was his unsupportive running shoes. When the foot collapses, or pronates, during running, push-off of the big toe occurs on the side of the toe as opposed to the bottom. This in turn creates friction, and when there’s skin friction, there’s callus. Using our scientific gait analysis video software, you can see how this runner’s right foot pronates significantly. This is made worse by wearing the wrong type of running shoe for his alignment.

If you or someone you know suffers from pinch callus, don’t wait until it causes pain. Make an appointment with your Sports Medicine Podiatrist to have it shaved down. Also ask them to check your gait for excessive pronation, which may be the underlying cause.

Sometimes a more supportive shoe is all that’s needed to reduce a pinch callus buildup and sometimes custom orthotics will be necessary to reduce excessive pronation. Either way, pinch callus is not protective and should not be ignored.

Life happens. Don’t wait.

IAFF Unanimously Supports Olympic 50 KM Race Walk (yay)!

It’s official – IAFF strongly supports the 2020 Tokyo Olympic 50 KM race walk event. Additional details can be found in the attached Press Release as well as an interview with Olympian race walker Evan Dunfee after he heard the news.

50km_Race_Walk_Press_Release

Canadian Evan Dunfee elated IAAF keeping 50K race walk

Thank you to EVERYONE who signed Chris Erickson’s petition and supported this important effort.

Special thanks also to Paul DeMeester, who flew to London to the IAFF Council meeting site, booked into the same hotel the IAAF were meeting in and delivered his impassioned plea for the saving of his event. Paul’s efforts were nothing short of heroic and represent the kind of commitment we should all have for causes that really matter.

 

Help Keep the 50km Race Walk in the Olympics

Patient and competitive race walker Paul DeMeester has been rigorously training to qualify for the 50km Race Walk Olympic Team Trials.

On 4/12/17 the IAAF will be meeting to vote on whether or not to abolish the men’s 50km race walk at the Olympic Games and IAAF World Championships and the 20km race walk moving to a half-marathon distance (21.1km). As supporters of these events, we should not, and cannot let this happen.

Please join us and sign your name on the attached petition to join the fight to save these historic, Olympic events.

https://www.change.org/p/ioc-iaaf-keep-the-50km-race-walk-in-the-olympics?recruiter=705740714&utm_source=share_petition&utm_medium=email&utm_campaign=share_email_responsive

Warmest regards,

Dr. Jenny Sanders

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

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).

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.)

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.

Product Review – R8 Massage Roller

Ultra-runner Oliver, just brought in a new toy to show me – the R8 Massage Roller. The R8 is a cross between a vice grip, inline skate wheels and a foam roller, and it’s especially designed to alleviate lower extremity muscle tightness.

Oliver swears by its effectiveness, especially for his iliotibial band tightness. My only caution is to concentrate its use on the fleshy part of the muscle only and to steer clear of bone. Other than that, I like its versatility and ease of use.

Not All Toenail Fungus Is Created Equal

A patient came into the clinic today with a bad case of toenail fungus. She had seen three other physicians in New York for treatment recommendations prior to making an appointment with me in San Francisco. These recommendations included expensive medications, expensive creams and expensive laser treatments. In spite of the high costs, these treatments are sometimes worth it, depending upon the cause. In her case, though, the particular type of fungus was caused by the continuous use of toenail polish..

Fungus due to frequently polished toenails is called White Superficial Onychomycosis (WSO), and is easily cured with a simple, inexpensive emery board file. Similar to the mold that grows on the surface of cheese, this fungus is easily filed off, leaving the healthy nail below.

Note that salon filing of nails is not rigorous enough to remove this type of surface fungus, so take matters into your own hands and file away WSO before you go in for a pedicure or polish change. This will keep the fungus from getting worse or spreading. It may also save you hundreds of dollars in treatments.

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.

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

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.

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.

2. 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.

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.

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.

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.

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.

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.

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.

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.

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/

Custom Converse Kicks

Roller Derby style setter, Admiral DeJenerate, just arrived with her new, custom designed Chuck Taylor’s. Check out the rainbow layered tongues.

Customizable options include both blank canvas or graphic editions. How cool to have complete creative control over your kicks design. Added pluses include – affordable cost ($75) and a two to three week turnaround.

Visit Converse.com for all the details.

Shoe Review – Adidas Supernova Sequence 6 vs. 5

I am a fan of Adidas Supernova Sequence 5, and I’m an even bigger fan of Supernova Sequence 6.

Both versions have a lightweight upper with mesh over the top, and sides of forefoot to allow for expansion around bony prominences such as hammertoes and bunions.

Version 6 is even more structured than version 5. This is accomplished by widening the medial support structure on the outsole, as well as minimizing the amount of hourglass in the waist.

Sequence 6 also has increased pronation control. The medial midsole has enhanced rigidity to de-accelerate excessive pronation.

All in all, Adidas Supernova Sequence is a great shoe. The only downside is that it’s only offered in medium width and runs narrow — so it won’t work for the wide foot.

Evaluating Athletic Shoes For Wear

It always surprises me when an injured athlete comes into the office with excessively worn running shoes and doesn’t know how old they are. Were the shoes purchased six months ago, a year ago? Has the athlete been wearing the shoes for more than a year?

Even though many factors contribute to wear, I always instruct my patients to write the purchase date of their shoes directly on the shoe insole underneath the sock liner to at least give them an awareness of shoe age and wear.

I then tell them to check for signs of wear every month starting at month six using the following YouTube video I produced as a guide:

http://www.youtube.com/watch?feature=player_detailpage&list=PL8FBD9F2021569064&v=ylgzgbzC9i4 .

Although excessive shoe wear can still occur, it is less likely to occur when using the above methods as opposed to simply replacing the shoes after an arbitrary 300 or 500 miles.

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.

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.

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.