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Poor Unfortunate Soles, Part 1: The Foot
Me: The only way to get comfy feet … is to get comfy shoes yourself.
Customer: You can do that?
Me: My dear, sweet child, that’s what I do. It’s what I live for. To help unfortunate soles like yourself.
Yes, I am a shoe expert who is happy to help you find the perfect shoe. (Well, shoes. You really need at least two to rotate between, but I’m getting ahead of myself.) But lest we find ourselves like mice knowing the ultimate answer to life, the universe, and everything is 42 without knowing the question being asked, you cannot find the perfect shoe without knowing your foot and its needs.
Let’s start with the bones.
A couple things I want you to note here: first, there are a lot of bones. While the foot seems pretty solid and inflexible, it is so because of strong ligaments and tendons, not a solid skeletal structure. Note that the biggest bone is the calcaneus or heel bone, and that it has a rather odd shape compared to the overlying skin. That large apparent backward protrusion is actually the anchor for two important connective tissues: the Achilles tendon going up the leg and the plantar fascia that goes along the underside of the foot. The “ball” of the foot is where the five metatarsal bones meet up with their corresponding phalanges, and the first metatarsal/phalange joint is known as the hallux. This is a major trouble spot. If the joint cannot bend in the walking process, one’s walking pattern will adjust, and the adjustment is normally to start rolling over the side of the big toe. This pushes the second big toe phalange into the other toes and the first phalange out the side of the foot. The protrusion it makes is what we call a bunion.
Let’s move to the nerves of the foot.
The big thing to note here is that if you scroll between this picture and the bones one, you’ll note that at the ball of the foot, the nerves actually run between the metatarsal bones. A shoe that is too narrow in the ball of the foot can cause the bones to pinch and aggravate those nerves, causing shooting pains, tingling, and numbness in the toes. (Proper name: metatarsalgia) The nerve between the third and fourth toes is so commonly aggravated it has its name: a Morton’s neuroma. (Quick and easy diagnostic tool for this ailment: lean in close to the foot. Push the third toe up and the fourth toe down, then alternate. If the bones are rubbing against each other enough to cause a neuroma, you’ll often be able to hear them click together as you manipulate the toes.)
Let’s add some connective tissue. This is a lateral (or outside looking towards center) view of the right ankle.
The picture shows all the different connections (and you can see how incredibly complex the foot is), but two tendons are noteworthy for their common problems: the calcaneal (or Achilles) tendon going from the back of the calcaneus up and the Fibularis (or peroneus) short tendon that connects the fibia to the fifth met. The Achilles tendon has two common issues: if the tendon is very tight, a shoe with no or even a negative heel will cause tendonitis, and if the back of a shoe is too tight, it can pinch, blister, or otherwise damage the tendon. The Fibularis tendon can be stretched if the foot is rolling out when one walks (a process called supination) or pinch if a shoe is too narrow.
For the king of foot problems, though, we have to go to the fascia. Fascia is the webbing under your skin that holds everything in place, and the plantar fascia on the bottoms of the feet is the cause of probably 75% or more of foot problems.
Quick note on terminology: “plantar” refers to the bottom of the foot. The suffix “-itis” means swelling. Thus, “plantar fasciitis” means nothing more than “swelling of the fascia on the bottom of the foot.” The main symptom is pain at the base of the heel where the plantar fascia meets the calcaneus, most prominently during the first few steps in the morning. Why? Well, the fascia has some small amount of elasticity, and all night long, it is unstressed. When one stands up in the morning, it is stretched, but it resists. In fact, it tears, and that is the pain one feels. As one walks around more, the fascia warms up, relaxes, and is better able to stretch with one’s movements. However, if left unchecked, the body will create its own solution to keep the fascia from tearing — it’ll just grow bone spurs to extend the calcaneus to meet the short fascia.
I would be remiss if I didn’t talk about another big cause of foot problems, though one that doesn’t start with the foot: diabetes. High blood sugar can damage and eventually kill nerves, and the nerves of the foot are often the first affected. Neuropathy generally starts with tingling in the foot and can lead to numbness or even complete loss of sensation, with all the problems that affect lepers.
Over the course of several posts, I’ll talk about how different shoes will help various different problems, but I also have some handy pain relief and foot health tips that require no shoe purchases at all. Really.
- Cool water foot baths. Whether you’re dealing with plantar fasciitis, tendonitis, or neuromas, the single best thing to take down the swelling is cold. If you read plantar fasciitis advice, everyone has a variation on this recommendation: rest frozen peas on your foot! Roll a frozen water bottle on the floor! I recommend just a cold water bath for a couple reasons. First, it’s much easier to keep your feet in cold tap water for ten minutes than tough out the pain of the ice; after all, nothing is less effective than therapy you don’t do. With cold water, you don’t have to worry about frost burns. Immersing your foot in water both increasing the surface area of your foot being exposed to the cold for better results, and more water means that it can trap more heat from your feet. You can use a fancy foot bath or just sit on the kitchen counter and let your feet soak in the stopped up sink.
- For ball of the foot pain (metatarsalgia) or neuroma: buy a set of pedicure toe spacers (<$2). While sitting or sleeping, wear them. This will gently pull the heads of the metatarsal bones apart and relieve the pressure on the nerves.
- For plantar fasciitis, stretching. Everyone again has their own version of this. (pull against a belt! write the alphabet with your toes!) I recommend a simple one, on the basis again that minimal compliance is always better than noncompliance. Before you take your first steps in the morning, sit up on the bed. With both feet, point your toes down. Slowly draw a circle with your toes so that at the top, your heel is pointing out and your toe is pointing towards you as much as possible. Then slowly finish the circle. Do this several times before you stand up. I like this stretch because it warms up not only the plantar fascia, but also the Achilles and all those other tendons shown above.
- On the subject of stretching, another good one for foot and leg health is to rest the bare foot against the modesty panel on your desk as close to straight out as you can get. Then try to sit up straight. If you’re like me, you’ll feel the stretch in your calves, thighs, and lower back, and as you get better about it, you’ll notice less sciatic pain.
Join me next time as I move from feet to the most important part of the perfect shoe: the perfect fit.
This series was inspired by @westernchauvinist here.
Part 2 has been posted here.
Published in Healthcare
Past performance is no guarantee of … yadda yadda yadda. Everybody’s feet are different. But I had plantar fasciitis twice and the only things I could walk in were Birkinstocks. To my surprise, along with the iconic sandals, they also make real closed-toe work appropriate shoes. Even hiking boots. (Though to be honest they are kind’a ugly). But, ugly or not, they helped me. I still have s pair in the closet … just in case.
The first thing that comes to mind is Dansko, particularly their clogs. I know Mama Toad can wax rhapsodic about them as well, but the short version is that they’ll give you the heel lift you need (maybe not a full 1″ heel drop, but 3/4″ at least) and have both backless versions and versions that have a hard back that doesn’t touch the Achilles at all. The back exists to meet dress codes, keep snow out of the shoe, and keep you from walking of the back. They also have great arch support and lots of other styles.
As for the stretching therapy side, I don’t think the heel lifts are going to help loosen the Achilles all that much since they don’t make the Achilles stretch. In addition to the morning plantar fascia stretch I described above, I’d work on hamstring/ sciatica stretches that put the foot perpendicular to the leg, the knee straight, and the leg perpendicular to the torso. In addition to the sitting one I described above, you can stand barefoot next to a bed or table. Keeping your knees straight and your butt sticking out, bend over and let your arms support your body weight. You’ll feel stretching in your calves, thighs, and hips.
It’s not style?!
I think the thing that helped my feet the most was losing 44 pounds of excess weight. I’ve found Merrell to be pretty decent for comfort. I’m going to look up Danskos now. My search for the perfect shoe, like underwear, is neverending.
Mine too.
I have had so many shoe problems over the last ten years. Finally about a year ago, I went into an expensive-sneaker shoe store. The woman who owns the store measured my foot. She insisted even after I told her I knew what my shoe size was.
What an unbelievable surprise: my feet have lengthened an entire size, from 6.5 to 7.5. I always knew that feet grew wider over time, but longer?
Well, having been measured correctly, now all the shoes I try on and buy and wear are fantastic. I’ve bought four new pairs of sneakers (including some Skechers, which are so comfortable I wear them instead of slippers!), and I feel so energetic.
I am so grateful to that insistent shoe store owner. I think of her almost every day when I put on my now-comfortable shoes. She gave me my life back. :-)
Let me know if you make progress on this front!
I have not. Reading up on it, I have some ideas for how to work around the problem, but yikes, that does not look easy to deal with.
Yep. The bones don’t grow, but all those ligaments holding them together stretch over time. Women in particular are prone to foot growth because relaxin, an imaginatively named hormone released during pregnancy, helps weaken all a woman’s ligaments to help ease delivery. I worked with a woman whose feet grew half a size with each child, and she had five.
And I once had a 95 year old customer whose foot ligaments and tendons had completely given up. When she put weight on her feet, every single bone was parallel to the floor.
Birkenstocks aren’t my go to fasciitis shoe, but they’re a good choice. (They have no heel to ball drop. I find a 1/2″ drop plus Birkenstock levels of arch support are more comfortable for most people.)
I’ll talk at length about arch supports, but for a Birkenstock aficionado like yourself, I would suggest looking into their Blue Footbeds. Great Birky comfort for your more stylish than Birkenstock shoes.
I wear only Skechers. Danskins reminds me of the time I went into a ballet shop needing flesh-toned tights for ballet class, and the sales clerk was black, and without thinking I asked for “flesh-colored” Danskins. I can still see the way she looked at me.
It happens in men too. Mine went from 9 in college, 9.5 in midlife, and now I’m a 10.
I think most women gain a shoe size with each pregnancy. I went from 7 1/2 B to 8B.
Any advice for those of us with nearly flat feet? I have no arch, and only a very slight instep. Not always easy to even find shoes as very firm insteps hurt like hell for me. I’m OK on work or dress shoes as generally I’ve done well with Rockports or Allen Edmunds – the latter have a cork layer inside that, like Birks, conforms to the foot at they’re broken in. On sneakers / athletic shoes, no reason to boycott Nike for me – they never fit me anyway – but otherwise I’ve had a dickens finding one that I can bear for any length of time.
I had one some 50 years ago. Still living with it. You have heard of a trick knee, well I have a trick foot.
We should all just assign Amy posts.
Love the title.
I find I don’t know exactly what my size is, or at least they don’t seem to have half sizes in places I shop for adult men’s shoes. I recently got a new pair of shoes at size thirteen which seem a little loose, but the size 12 felt like it would be tight.
I guess i’d be a 12 1/2 if they have that. This is all kind of a moot point now, since I am in a wheelchair. I guess I get to save money on shoes, as I had my previous pair for three years.
You’re inspiring me to make further changes to my life–even to spend more money on a still better pair of shoes!
My wife will no doubt be pleased.
What a great data-rich post!
Thank you, Amy!
Thanks for the post! I’ll be keeping tuned. My plantar fascitis showed up around the first of the year. I’m a General Contractor and on my feet all day. One day I’d like to find a work boot that will help, and I’d love to start running again, but for now, the only way I can keep my feet relatively pain free is by icing, stretching, and wearing Kurus or high support running shoes, and I get my exercise on a stationary or actual bike. I have a couple of orthotics I’ve tried, but I’ll be looking for your post on how to best use those. I was able to play in a soccer tournament Labor Day weekend and I put in four games in one day without any major pain repercussions haunting my heels for the following week. This was a major victory considering how constantly I’ve been trying to manage pf for the last 8 months.
I’ve got some compression sleeves for plantar fascitis that I’ve used (mostly for athletics) and they seem to help a bit. I’d be interested to see if you have any insight into how those work/help, or if it’s just psycho-somatic. If I’m honest, my good foot health prior to the onset of PF had me thinking that orthotics, sleeves, and expensive shoes were all psycho-somatic. Classic myopia… now I have all of those things.
I’m not a huge fan of sleeves. They work in two ways: first, by exerting pressure to keep blood from pooling in the feet and so prevent swelling, and if they’re designed correctly, they prevent the foot from relaxing to its preferred angle, which keeps the fascia stretched at night. And they really do work for that — for folks with severe fasciitis they’re a much cheaper and more comfortable alternative to the rigid plastic boot that some podiatrists prescribe sleeping in.
For everyday wear, though, I think there are better ways to stretch and support the fascia, and as for reducing swelling … well, feet have a hard enough time getting good circulation as it is. Deliberately reducing blood flow to prevent swelling, particularly on a routine basis, is a bit like cutting off one’s nose to spite one’s face. I’d rather reduce swelling with cold, elevation, and exercise.
Part 2 has now been posted!
http://ricochet.com/555481/poor-unfortunate-soles-part-2-the-fit/
Lying here in bed grooving on today’s foot pain, I found your posts while trying to find reading material to distract me from the pain. Why are professionals either uninformed or chintzy with dispensing their wisdom, let alone proposing solutions for relieving the suffering?
But you, you get an A.
It has been almost 2 full months since I broke my 4th toe on my left foot, and I am just now able to walk flat footed across a room. I don’t dare try to bend my toes yet as for some reason, even with my foot at rest, massive pain invades that toe and the bones below it. It will last for 5 or 10 minutes then fade away. Have an appt with the ortho clinic Friday the 28th.
Sounds like some kind of nerve issue. Hope they can work something out without surgery!
There will be no surgery as I am too darn old to put up with it. I kicked the lower bar of an exercise machine accidentally and the 3rd and 4th toes exploded. Only the 4th was broken but the 3rd hurt for weeks, so probably was nerve damaged in both of them. Both toes were badly swollen and the broken toe is still swollen. If the x-rays show the broken bone is healed, I can then start exercising the toes and ball of my foot and maybe work out the problem. I have been exercising the ankle back and forth and up and down.
This been mentioned on Divine Help?
No, I don’t pray to Hashem for piddling stuff. My own fault for not turning on a light because I’m so cheap about using electricity. The doctors bills are a hundred times more than 10 minuets worth of an electric light. I was locking up the back door and thought I could make it back through the living room by the light from the kitchen. I have a comprised vestuble system and when I started to fall, threw out my foot to regain my balance. Big mistake. Heh.
The New Testament (Philippians 4) says, “in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus.”
But I have to admit I can’t think of any Tanakh verses about this!
Expensive side-effects of trying to save money on electricity. Just the sort of thing I’d do!
Went back to the orthopedic clinic today and good news! Doctor’s visit was better than well. Ex-rays showed new bone growth around the break and I can now discard the boot. Doc said I could bend and exercise the toes just not to put my full weight on them. So all good.