PODIATRY

Are your shoes talking to you? It’s time to learn their language!

Patients are genuinely surprised at the insight we can gain from examining wear marks on their shoes.This is not intended to be an exhaustive language course, rather an insight into some indicators of abnormal shoe wear that tell us that all is not well in your foot function.

All shoes will eventually demonstrate abuse and high mileage. These are characteristically symmetrical and predictable. This week I had a beautiful example of abnormal shoe wear and a clear demonstration of some of the most common signs of instability.

This above view shows the shoes sitting on a flat surface from the rear. The arrow pattern at the back should be perpendicular to the supporting surface. In this case, the shoes have distorted and now collapse inwards. Distorsion like this is likely occurring as a result of over-pronation due to a structural deformity. Now the deformity in the shoe will make the foot even more unstable. So time for a new more stable shoe and identify and treat the origin of the force.


Functional hallux limitus, is a fancy term for describing that a normal big-toe joint locks during walking causing a host of problems like ingrown toenails, bunions, thickened dark nails, bunions, osteoarthritis to name a few frequent flyers. The giveaway for this in the shoe is a bump in the top of the toe box or in modern running shoe, a hole appears where the tip of the toe tries to form an escape route. Identifying its presence is the first step, finding what caused it is our job.


Holes in the interior lining at the rear of the heel cup is NOT normal. Nope! stop trying to explain it away, its not normal!.

This a great shot and again its the same individual. As the heel rolls in excessively the liner of the shoe is destroyed. The irregularity of the fabric can compound an existing inflammatory situation by adding physical friction. Symptoms of achilles tendonitis, retro calcaneal bursitis, exostosis, blisters and even ulceration are likely partners. Yes absolutely new more stable shoes are needed, but without addressing the mechanical instability the result will be the same.


With excessive pronation the foot progressively twists inwards through the mid-foot. A weak shoe will make this worse, and severe pronation will destroy a weak shoe in short order. If you’ve suffered through a biomechanical consultation with one of our practitioners you’ll be rolling your eyes at this point (if not here is how to test a shoe for stability).

This was an ok shoe when new but clearly not up to the challenge, and the challenge went on wayyyyyy too long.

Having identified the presence of a significant functional instability our primary goal is to determine the true cause. Along with our physical exam and history taking the most valuable diagnostic tool we have in our arsenal is our Pedi Technology video gait analysis. By analyzing our patients walk-in HD slow motion, we can pinpoint the source, educate our patients as to the why, and present what options they can choose from to best address their problem.


 

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