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1362 Views 2 Replies Latest reply: Mar 23, 2012 10:55 PM by JamesJohnsonLMT RSS
GoldCay Rookie 4 posts since
Mar 23, 2011
Currently Being Moderated

Mar 22, 2012 8:57 AM

Foot pain and shoes...my feet are confused!

This is a bit of a long story - so if you have time I'd greatly appreciate any feedback.  Starting in mid 2009, I got back into running after two kids, aiming for weight loss etc.  By end of 2009, was averaging around 15 k per week.  Was having hip pain and got fitted with foot levelers for my running shoes.  They worked great and fixed the hip pain. At this point in training, I wasn't paying much attention to what shoes I was wearing - live on a small island in the carribean and bought what I could find in my size.  By June 2010 was up to between 15-20k per week and needed new shoes.  Went to a running room in canada and was fitted with Asics stability shoes - Gel 1150 or similar.  They worked great and I continued running. Signed up for first 1/2 marathon for December and accordingly my mileage went up.  Dutifully replaced my shoes as the mileage ticked by and stayed in Asics stability, though had to compromise on exact model a few times.  All through my 1/2 marathon training I kept the orthotics in.  Over time I had increasingly sore feet, mainly my right foot and in my arch - but the outside edge of my arch.  My husband kindly massaged them regularly but he kept remarking that something was weird in my foot.  Did the 1/2 in Dec 2010 (2:04!) and kept up the running albeit not at half marathon pace.  The foot pain lingered but I just figured that was my lot in life and I'd have foot pain forever.  Signed up for the same 1/2 in Dec 2011 and once I started the long runs, realized that I couldn't bear the pain anymore.  Went to a physio and she spent a lot of time looking at my feet, my orthotics, my shoes etc.  Turns out my midfoot bones were all jamed together and surrounded by crazy muscle tightness, spasms etc.  Took about 6 weeks of physio, but eventually my feet finally felt better.  I backed out of the 1/2 marathon as I was then too far behind in traning as it was now November.  Physio recommended I remove the orthotics, which I did immediately. She felt the arch correction was too severe and the cause of the foot issues.  I did that and the hip pain didn't come back.  She also suggested I switch to a neutral shoe as she didn't see any overpronation issues in my arches.  I tried a neutral brooks shoe, but unfortunately bought the wrong size.  Didn't get another chance to buy new shoes until recently and went for a Nike neutral - Pegagus 28.  I've been using them for a week and I'm not convinced.  This mornings run resulted in terrible pain in the middle of my right arch...not a good sign.

 

I feel like my feet are confused - do I need a stability shoe, with or without orthotics, or do I need a neutral shoe, with or without orthotics.  I really wanted to try a neutral Asics shoe, but none were to be found on island.  Next time I'm off island is in the summer so I've got 3+ months to deal with.   Should I go to a podiatrist and get an assessment done of what I really need? I have a lot of faith in my physio so trust her judgement. I've just had difficult following through on her suggestions due to shopping issues. 

 

Any help/suggestion/advice would be greatly appreicated!

Thanks,

Leanne

  • Damien Howell Legend 312 posts since
    Feb 27, 2008
    Currently Being Moderated
    1. Mar 22, 2012 4:20 PM (in response to GoldCay)
    Foot pain and shoes...my feet are confused!

    Take a look at short article Motion Control Shoe Increases Risk of Pain and Injury, and Arch Support and Orthotics - Use and Misuse.  From you description it sounds like your Phyiotherapist has been guiding you in the correct direction.  Get back in touch with your Physiotherapist for an answer. 

    Damien Howell PT, DPT, OCS

  • JamesJohnsonLMT Legend 1,155 posts since
    Aug 23, 2009
    Currently Being Moderated
    2. Mar 23, 2012 10:55 PM (in response to GoldCay)
    Foot pain and shoes...my feet are confused!

    Sometimes, shoe salesmen and healthcare providers can't see the forest for the trees, no matter how skilled or well-educated they are. A few things need to be explained so all can see clearly.

     

    Arches themselves were never meant to bear weight directly, or they would not be raised off the ground in a normal foot. In instances of pronation, a low arch or a flat foot, this is still the case. Propping up an arch, whether it is with a shoe, an orthotic or other device, does not strengthen it, any more than walking on crutches is good for your armpits. I am glad you are no longer using artificial support for your arch. Kudos to your PT for weaning you off such dubious interventions.

     

    Arches are maintained by tough tissue called fascia on the plantar surface of the foot, evidenced by the "windlass effect" which raises the arch when the toes are pulled up in dorsiflexion. Arches are also maintained by the Tibialis Posterior muscle that resides between the Tibia and Fibula bones in the mid-rear calf. One can argue that a weak plantar fascia and/or Tib. P. contributes to a flattening of the arch and resulting instability of the footstrike, and that jacking up the arch with some device or shoe somehow replaces these musculofascial functions. Alas, you have seen the results.

     

    On the other hand, the fact that you now do not need your arch supported does not necessarily mean your foot is ideally suited to running in minimalist shoes, or that cushioned trainers will be the most stable platform for your running future (cushioning can increase instability). You will, however, need time to adjust to any change in your footwear, especially when prosthetic devices have been suddenly dispensed with. Not only your feet, but your core muscles need to adjust. The relation between the foot and hip, for example, is very strong, as you saw when you first used the levelers.

     

    A few years of running under your belt, and the hip muscles have no doubt strengthened, especially after excess hip rotation was no longer required when you were in the stability shoes. The obvious question is why the stability footwear took away the hip pain in the first place, which directs attention back to the foot as a source for the previous hip pain. They now may be the cause of your arch pain, by way of yet another muscular compensation.

     

    Pain in the high arch of the foot can come from a number of causes. Narrow and/or roughly constructed midfoot design (the "waist" of the shoe) is one possibility, especially when you are having trouble finding the shoes you really want. Though you did not mention whether your previous wrong-size shoe was sized up or down, an arch support or post in the shoe can be in the wrong place and cause some irritation. Sometimes, tight lacing is the problem, but my money is on muscular compensation, because you had it before, only in a different place. Three years of training have made you a different runner from a muscular perspective, but I doubt there has been any change in your bone structure.

     

    You may not have a collapsed, or pronated arch upon examination, but almost everybody pronates (except for those with the most rigid arches) while running, as a way of absorbing shock when the foot would otherwise slam to the ground. What may be normal pronation for some could be overpronation for others, depending on the structure of the foot in question, and pronation of any kind involves movement of joints, muscles and tendons to accomplish. A sudden change in footwear can bring about a sudden change in muscular compensation, as you were delighted to find with your hip. The flip side, is that you may now be relying more on the stabilizing muscles of your lower leg to replace the former stabilization of your shoe.

     

    Before I go on, other factors - such as using the right leg when driving a car, or running around a track in the customary counter-clockwise direction - can cause unbalanced pain in the right foot, leg, or hip, but I am going to discuss muscular compensation as if those factors were not present.

     

    First of all, any excess motion of your foot, leg, or hip would need to be observed either directly or via video. If your PT has not already arranged this, even an amateur video of your running can be helpful. Perhaps a run in the parking lot, or on a treadmill will do. Once again, what is normal motion for some may be excessive for others. It depends on how you are built. Now I will discuss what that could mean to your running, your footwear, and your pain.

     

    High arch pain can come from stress in the upper muscle of the rear calf, which could be set off by toe-raise exercises or anything else that tightens the muscle. This neuromuscular pain-referral pattern is well documented. The Tib. Posterior muscle that I referred to earlier, slides its tendon beneath the achilles tendon and underneath the rear ankle enroute to the arch. Is your pain at this location?

     

     

    http://l.yimg.com/a/i/edu/ref/ga/l/442.gif

    If so, there could be pain stemming from this muscle's attempt to maintain the arch, now that it is no longer being supported. It could also be from excess movement in the tendon sheath or from strain to the tendon itself. Occasionally the muscle gives out and becomes lax, leading to the eventual flattening of the arch. Conversely, some runners have rebuilt the arch simply by running barefoot or in minimalist shoes, indicating the importance of muscle to the height of the arch. So, the question is, what could cause excess motion or the lowering of the arch in the firt pace? Such motion could have an impact all the way up to the hip, as a means of turning the foot outward as it rolls onto the arch.

     

    This is an example (from Medscape) of a normal foot structure...

    http://img.medscape.com/pi/emed/ckb/clinical_procedures/79926-1412901-1922965-1939386.jpg

    Followed by an example of a short 1st metatarsal, still considered  normal, but less mechanically advantageous. See how the second  metatarsal bone projects further from the arch than the 1st., in this  case the toe (phalange) as well...

     

    http://img.medscape.com/pi/emed/ckb/clinical_procedures/79926-1412901-1922965-1939388.jpg

    This last image shows the best arrangement, even though the second toe extends further than the first. In a case where the 1st metatarsal is shorter, it helps to visualize by placing your hand on a flat surface and lifting it up onto the fingertips, as a way of illustrating the toe-off phase of your footstrike. Not so comfortable imagining the entire weight of your body on that one middle fingertip, is it?

     

    When babies crawl, they turn their hands outward and roll them inward in pronation, to shift the weight onto the stronger bones of the thumb. In the same way, the foot pronates to shift weight onto the 1st metatarsal when it is too short to provide a stable toe-off, as in the second to last image. That rocking back and forth of the foot, depending on the individual, can lead to repetitive motion injuries or pain, all the way from the foot to the hip. This bone arrangement is so common, it is often overlooked even by podiatrists. For a runner, though it is almost a guarantee of excess motion and the pain that attends muscular compensation.

     

    While an early attempt to prevent this motion with the levelers was initially successful, such interventions eventually fail because they lead to restriction of natural movement. If this is the case with your foot, a special type of orthotic can be crafted to provide prosthetic support to replace a short 1st metatarsal, without propping up the arch or interfering with the normal motion of the foot. Once this proprioceptive cue is supplied to the base of the foot, the muscles no longer need to compensate via excess motion, and will in time be orchestrated properly. It takes a little while to retrain this aspect, but it works. You just have to have the shoe modified by someone who knows what I am talking about, or do it yourself as I have.

     

    Again, these are some of many possibilities. The history with the hip, the levelers, the temporary relief from support shoes/orthotics, and the arch pain, all reveal many clues that make perfect sense to me. By all means, continue to explore options that are professionally recommended, but a thorough assessment demands that all these factors be accounted for, starting with an analysis of your foot in motion during running. Odds are, there is excess motion there that affected the hip before correction, and now manifests elsewhere.

     

    It took me a  few years and several injuries to learn how to fine-tune my shoes and  technique. The breakthrough for me was to exchange denial for a proper  assessment of my bone structure, and to apply minimal compensations  where they were needed, and nothing more. I tried stability shoes,  orthotics, arch supports, and heel lifts, before settling on small  quarter dollar sized pads under my 1st metatarsal to effectively extend  them. I haven't had excess motion issues in foot, leg or hip since then,  and my shoe wear is even.

     

    I hope you have similar success. If there are any doubts about the foot, consider consulting a podiatrist, since everyone has been commenting about problems down there. Try to steer them away from any talk about conventional orthotics if that is the case. Good luck!

    Followed by an example of a short 1st metatarsal, still considered  normal, but less mechanically advantageous. See how the second  metatarsal bone projects further from the arch than the 1st., in this  case the toe (phalange) as well...

     

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