Hallux Limitus vs. Hallux Rigidus

Reader Mike writes“I was recently diagnosed with functional hallux limitus after developing a strong interest in hiking (and having never done any other long distance running, or walking type things before that) Do you have any recommendations for a good hiking boot/shoe? I’m currently using Montrail CTC.”

Hallux limitus is a condition whereby the big toe joint becomes restricted during weight bearing but is otherwise healthy, hence the name functional. In this condition you still have cartilage with little to no arthritis in the joint. Pain arises with excessive flexion of the great toe or while standing due to pronation and rolling onto the big toe joint, causing restricted motion.

In Hallux rigidus, the great toe joint becomes arthritic with associated cartilage loss, resulting in bone on bone motion which is very painful. This is a structural problem usually requiring surgery to correct.

In hallux rigidus, you want to stop motion, in hallux limitus you want to reduce motion. For both conditions an inflexible or stiff soled shoe is usually best which fortunately most hiking boots have. I have several patients with hallux rigidus, who I have wear only hiking boots becuase this eliminates the pain. For my hallux limitus patients I can usually stop the pain by getting them into shoes that are primarily inflexible in the forefoot. Montrail CTC is a classic example of this. Custom orthotics can also help since they improve big toe joint function.

For even more information about hallux limitus read my other post http://drshoe.wordpress.com/2008/01/08/shoe-design-for-hallux-limitus-ie-turf-toe-non-bunion-pain/ which talks about sole design.

Shoe Review – Mizuno Wave Rider 11

In general, Mizuno shoes have great uppers and not so great, soft compressible EVA midsoles or lowers. Because of this, they tend to wear out more quickly then other shoes having more firm medial (inner) EVA outsoles.

CF brought in her Mizuno Wave Wrider 11 shoes in today for evaluation after she started having heel pain while training in them for the Nike Women’s 1/2 Marathon. The shoes were less than 3 months old and barely had 150 miles on them, when the pain started. Fortunately she purchased a new pair for the event and although the pain did not go away, it did not get worse after the Marathon .

The above image shows her 3 month old shoe on the left and her new shoe on the right. Notice how the left shoe is listing to the outside (lateral)? This is because the white EVA midsole has compressed, which tilts the shoe, holding the foot in less than optimal alignment.

The image above shows asymmetric wear in the old shoe with the right shoe outsole being entirely worn off (no pink tread), making the outer forefoot less durable and more likely to pronate, resulting in heel pain or plantar fasciitis.

In this case, even a relatively new shoe can cause foot pain and problems while running. If you wear Mizuno’s, especially the Wave Rider 11, you will want to evaluate your shoes for signs of excessive wear at least monthly.

Shoe Review – Aquatalia Wasabi Boot & Whoopie3 Loafer

If you have a narrow foot then I don’t have to tell you how frustrating it can be trying to find a pair of boots that fit. If you’re looking for a stylish, waterproof boot, then Aquatalia’s Wasabi knee high boot is not only fashionable but narrow and shallow as well. It has a great rubberized sole to help with shock absorption and will get you through even the wettest days.

Aquatalia also makes a patent leather loafer on the same last, with the same low volume upper and narrow outsole – Whoopie3 which is shown below.

Aquatalia’s website is http://www.aquatalia.com/ Check it out for new styles!

Great Shoe Site – 6pm.com

For those of you who love the ease of ordering from Zappos.com, you may want to check out their other site, http://www.6pm.com/ which features the same multi-view shoes as Zappos.com, only at deeply discounted prices. The shipping policy is not as liberal (free outbound only with orders over $100) and their return policy is shorter (30 days as opposed to 365), but given the deals to be had, this site is well worth it.

Barefoot Running, Nike Free, Vibram FiveFingers etc.

Reader Tricia aks I’ve just purchased a few pairs of Vibram Five Fingers shoes and would love to know your thoughts on the assertion of (near) barefoot running resulting in much stronger feet and ankles, and fewer overall injuries. The anecdotal information I’ve seen on blogs, Runner’s World shoe review, and the Nike Free shoe makes logical sense, and I’m not sure why more athletes haven’t incorporated this into races. One racer from my previous location (Anton Krupika, winner of the Leadville 100 Trail Run) often ran barefoot. I’m interested in stronger feet and ankles and improved marathon times to get back to Boston for my 3rd try at a personal best.”

Great question, no simple answer. As a podiatrist most of the feet I see, runner or otherwise, are biomechanically challenged having alignment issues. Therefore, support and shock absorption become the important issues.

Over 75% of my practice is made up of athletes, from ultra distance runners and ultra ironman competitors to the 2 mile per day joggers. Universally, the issue isn’t a particular shoe, but rather the fit which matters. Shoe manufacturers unfortunately don’t talk about fit, but rather construction (stability, motion control etc), which I think is a disservice for anyone trying to find the right shoe.

In theory, strengthening ones feet and ankles by not wearing shoes, makes some sense. In practice however, most of the problems I see, are due to lack of support or the wrong shoe fit for a given foot.

Take Nike Free (above) or Newton http://drshoe.wordpress.com/2008/06/25/shoe-review-newton-running/. Great fitting flexible shoes, unless you have a narrow shallow foot that has pain due to arch collapse. In this case, although these shoes might be great for someone else’s foot, they would spell disaster for this foot type.

I recently treated an Asics sponsored Triathlete who had been wearing a perfectly fitting narrow shallow pair of Asics shoes (Gel Kayano). When his sponsorship changed to Brooks, so did his shoes (Addiction narrow) which were followed by 6 months of one injury after another because of the deeper, wider Brooks shoes.

If you’re trying to improve your time and you’re injury free, my recommendation would be to go to a highly specialized running shoe store, to evaluate your running style and match your foot to the proper shoe.

Difficulty Fitting Orthotics Into Shoes

JLC writes “I have very high arches and just bought my first custom orthotics but have not yet found a pair of shoes that work with them.”

Finding shoes to accommodate an orthotic can be a challenge. If you are ordering orthotics, be sure to show your podiatrist the shoes you plan on wearing them in, so that an appropriate pair can be made. If you’re primarily wearing flats and your orthotics are made for tennis shoes, they generally won’t work in your flats.

On the other hand, if you already have orthotics the profile may be able to be reduced, i.e. narrowing and/or removing length. A 3/4 length orthotic works just as good as full length orthotic, so shortening can usually help. The below images illustrate this principle.

Unfortunately, most non-athletic shoes will not accommodate an orthotic. Typically orthotics are too bulky unless your podiatrist orders a “dress shoe” or lower profile pair. This type of device is illustrated below. If you never wear athletic shoes, then this is the type you should have for your shoes. This style of device is sometimes called a cobra based on the design shape.

An orthotic made for a pair of flats or dress shoes will never be as good as a pair for athletic shoes, so if you can it is always best to have both pairs. Generally the 2nd pair is not as expensive as the first which helps.

Squeaky Orthotics – Part 2

I addressed squeaky orthotics in a prior post http://drshoe.wordpress.com/2007/12/27/squeeky-orthotics/ which illustrates how to apply tape on the underside of an orthotic to stop squeak.

Reader Sarah read this and asks “I have tried this many times, and the tape always comes off. Hockey tape gets all gooey and comes off in a lump, as well as leaving your shoe quite sticky. Masking tape just wears off. What tape works well?”

When tape works to eliminate squeak but won’t stay put, the best thing to do is have your podiatrist permanently glue a piece of leather or vinyl to the underside of the orthotic in the same place where the tape was. Typically Barge (shoemakers waterproof glue) is used. If your podiatrist doesn’t have the necessary materials then your local shoe repair store will. 

 

Shoe Review – Brooks Addiction 7 vs. 8

The Brooks Addiction is similar to the Beast in that it is wide, deep and very stable which is good for heavy pronators. Recently the Addiction 8 was released and it is a significantly different shoe than the Addiction 7.

Toebox Length and Depth – Substantially longer toebox in the Addiction 8 vs. the 7. This may be good or bad depending on whether your heel to ball or heel to toe measurement is longer http://drshoe.wordpress.com/2007/12/05/size-matters-heel-to-ball-vs-heel-to-toe/ The toebox depth in the Addiction 7 is much deeper than in the 8, or put differently, the 7 has more overall volume than the 8.

Width and Outsole Shape - The Addiction 8 is much narrower and has a much straighter last than the Addiction 7. If you have been successfully wearing the 7 you may need to go wider in the 8.

Overall, I’m pleased with the changes and much prefer version 8. It is more streamlined and proportional to the average foot than then 7. If however you have short toes, then you may want to try the Brooks Dyad, which has a shorter toebox than the newer Addiction 8.