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Saturday, September 1, 2012

If Your Feet Hurt - Read This!

 This is a 're-run' of my most 
comprehensive article...

Although this article is focused on patients recovering from Lisfranc's Injuries - this article covers everything you need to know about finding comfortable shoes and getting significant improvements in foot, knee, hip and lower back pain.


Shoe Recommendations 
For Patients Recovering From
Lisfranc Injuries...
(As well as any Sprain or Fracture of the Foot)

I know this sounds terrible but 
I love treating fractures...

I enjoy treating patients with fractures because:

1. On the 1st visit, patients will leave the office in significantly less pain than when they walked into the office using simple non-painful conservative treatment. 

2. Once the fracture is healed - we focus on getting patients into proper shoegear, arch support and possibly bracing so they can get back to doing all the activities they enjoy! 

I love my profession because I have the opportunity of helping people heal from foot and ankle injuries and get back to their lives.
Over the years, I have discovered that if patients follow the recommendations below - our success rate is amazingly high!


So, let's talk about Lisfranc Injuries...
The Lisfranc Joint (also known as the Mid-Tarsal Joint) is in the midfoot and, in my opinion, it is the most common foot injury. 
Although it can be caused by direct trauma (and if that happens - you are going to the Emergency Room and possibly having surgery), I find that the wide majority of Lisfranc Fractures or Sprains are caused by an often minor twisting of your foot on a stair or curb and, if you happen to be barefoot, wearing flip-flops or a shoe that bends through the midfoot area - there is a very high probability that you are going to break a bone or pop a ligament.  

I see this type of fracture every single day
One day last week I saw four Lisfranc fractures before lunch. The amazing thing was not one of them knew how they did it!

In my opinion, this fracture is caused by taking a
wrong step in a crappy shoe!
And it's not you're fault because 
80% of shoes out there are crappy 
and there is tons of misinformation about what makes a good shoe...

One of the main reasons I started the blog was because of my frustration with all of the misinformation about shoes.
I'm passionate about this topic because I have spent the last twelve years in private practice striving to help people heal foot injuries and get back to their lives.

These Rules Are Stringent 
You ARE Recovering from a Foot Fracture
and you need to protect your foot!
You went through a lot of pain and time in "the boot" or on crutches to take the chance of wearing bad shoegear and re-injuring...



1. No barefoot! 
The only time you are barefoot and standing is in the shower. 
2. No Flip-Flops. 
I don't care how "good" they say the flip-flops are - they're not. 

3. No Walking Around the House Wearing
Only Socks.
 Zero biomechanical protection. 

4. No Flimsy Bedroom Slippers.
Any slipper that bends or flexes is garbage.

5. As a bedroom slipper around the house - wear Croc RX Clogs with the strap 
in the back.  
As soon as you get out of the shower, dry yourself, put on your Crocs.
If you get up in the middle of the night to go to the bathroom, when you get out of bed, straight into your Crocs and off you go.
Yup, the strap MUST be to the back. 


1. A Thick Rigid Sole
If you can bend or flex it - it is garbage.
Put some muscle into it, please - no wimpy "bends"...

2. Arch Support
Whether it is Custom-Molded Arch Support or an Excellent Over-The-Counter Insert - you need arch support.
Unless you are one of the 10% of people who can't tolerate arch support in which case, do not wear arch support. 

3. A Wide, Soft Square Toebox. 
Google: Extra-Depth Shoes and there are many brands of shoes that have extra-depth for the toes.
No cock-roach kickers, please -- they are bunion factories. 

4. Rearfoot Control. 
Every single shoe MUST have rearfoot control. 
If you are not biomechanically controlling the rearfoot - you are not controlling the mid-foot - which will lead to more chance of re-injury, pain, strain as well as knee, hip and lower back mechanical strain. 
To stay in a backless shoe, you are gripping your toes down when you walk. There are tendons that start below the knee and go all the way down to your toes - they are also passing through or connecting into the bones that make up the Lisfranc's Joint and a biomechanically uncontrolled rearfoot equals more strain, more pain and more chance of re-injury. 

(Any midfoot fracture or Injury)

Good Morning!
 I have to let the dog out so I guess I'll get out of bed and right into my Crox RX Clogs 
(making sure that the strap is to the back) and let the dog out. She's fascinated with the Geckos and Hummingbirds...

I'm going to put on my Diabetic socks (even though I'm not diabetic), my Tri-Lock Brace, which I got from my Podiatrist and I use when exercising (for at least 6-12 months after a Lisfranc's Injury) and I'm going to put on my 
New Balance walking shoes so I can take my dog for a thirty minute walk. 
Luckily, my Podiatrist sent me to the New Balance store and gave me a prescription for:
New Balance Walking Shoes
with Roll Bar Technology and
a wide base for more stability
(Because it's an RX and medically necessary it should make them tax deductible...)

My foot feels pretty good so I don't need to wear my brace to work today -- but I'm going to take my Tri-lock brace to work so that if my foot hurts I can put it on. 
I went to Dr. McCarthy's blog and found the search box (top right hand corner) and searched for:
"Top 20 Women's Comfortable Dress Shoes"
and found a great shoe for work. 
I wrote down what I liked and went to the store to try them on -- my brace fit into some of them but not all so, in the early days of recovering from my injury, I wore the chunkier shoes with my brace and once I was further along in the healing process, I didn't need my brace anymore. 
Anything on this list would be fine with someone who has healed from a foot fracture
because I know all of these shoes meet her criteria on that stringent list from her blog...

Go Play!
Wow, I can't believe it! Work shut down early and now I can go do whatever I want! 
Let's look and my options...

I'm going to wear my Amphibious Teva's or Chaco's (with a rearfoot strap) whether I am on the sand or in the water because it'll be more comfortable and I'll have more fun. 

Water Aerobics
Am I going to do water aerobics barefoot? 
Oh heck no! 
My Pod told me she sees a surprising number of fractures from women bouncing around in the swimming pool -- I think I'll wear my Amphibeous Teva's (with rearfoot strapping). Right after I was recovering from my foot fracture, I had to wear a pair of New Balance Walking Shoes with Roll Bar Technology and a wide base (for more stability) in the pool

I didn't like any of the hiking boots Dr. McCarthy featured on her blog so I went to REI and I picked out a boot I liked but I made sure that the sole didn't flex or bend. The salespeople must have thought I was crazy because I walked around -- bending and flexing all the shoes before I tried them on. I then picked a great boot that felt the best on my foot and met all Dr. McCarthy's criteria for proper shoes. 
She told me that no matter what she says, 
I'm the acid test. 
 If I try on a shoe and it's not comfortable -- 
I don't get it. 
I don't care what anybody thinks! 
I went through too much to get my foot healed to risk re-injuring it by being barefoot so I am going to wear my New Balance walking shoes with Roll-Bar Technology and a wide base
I love Yoga and I want to keep doing it so 
Dr. McCarthy wrote me a prescription that I gave to my Yoga studio that says it's medically necessary for my to wear my shoes in class. 

Home at Last!
I used to not want to wear my Croc RX Clogs around my husband because I thought they were goofy but, guess what -- I got him in Crocs Rx around the house and he had the following benefits:

30% Improvement in knee, hip and lower back pain within 3 weeks.

We saved a truckload of money in medical bills - everything from foreign bodies, warts, tendonitis, fractures, heel pain, calluses, ect.

His feet are prettier! 
Turns out that kooky Dr. McCarthy was right! She said, "You're either beating up your feet or you're beating up your shoes -- think what your shoes look like after a couple of years -- that's what's happening to your joints."

Good Night!
I'm so glad that my day tomorrow doesn't include going to see my Podiatrist! 
We got the fracture healed and as long as I do the right things when it comes to protecting my feet, 
I don't need to see her. 
I can live my life and have fun!

I wonder why a Podiatrist would be giving out advice that would decrease her business?
 Hmm, I wonder if it's because she figures it's a better marketing plan to fix people's foot problems and then protect their feet with proper shoes so they don't need to keep constanly coming back and she gets new clients from "Word of Mouth" referals from happy patients? 
That must be it...

Have a Great Day!

Dr. Cathleen A. McCarthy




Nancy Smith said...

Thank you so much for your article, it was very informative. I was recently diagnosed with hallux limitus. Can you make some recommendations for women's casual dress shoes. Thank you in advance. Nancy S.

Doctor of Podiatry Discusses and Recommends Shoes. said...

Hi Nancy,

Thanks for reading the blog! For a casual dress shoe, my 'go-to' recommendations are the closed-toe Wolky Cloggy or the Alegria Paloma or Feliz. For a great sandal, check out the Naot Paris and for a cute casual shoe to wear with jeans, try on the Dansko Volley. For an exercise or walking shoe, try on the New Balance 928.

I hope this was helpful and thank you again for reading...

Anonymous said...

I appreciate the informative and entertaining post. My feet have hurt most of my life, and I was sadly excessively vain about wearing comfort shoes. Fortunately there's nothing structurally wrong with my feet so I've dodged the bullet (so far). I'm a comfort shoe convert, and appreciate that you provide clear suggestions and reviews of shoes designed to be both functional and attractive.

I have tried on Dansko, and this brand feels hard on my feet. Is there an alternative which provides the structure of a Dansko but with lots of cushioning?

Doctor of Podiatry Discusses and Recommends Shoes. said...

Hi Journalofplacestobe,
Thank you for the kind words! I would recommend trying the Wolky Cloggy (there's an open and closed toe for different seasons) and the Alegria Feliz and the Jambu shoe line. Check our my article on "Top 10 Comfortable Women's Dress Shoes" for more ideas. If I was a betting girl - my money is on the Wolky Cloggy!
Have a great day!

Est said...

Hi. Thanks so much for this blog! I think its the only one of its kind..
6 months ago I had a Lisfranc injury to my left foot- 4 fractures and dislocation. I had surgery to have 4 plates put in that were held there with 13 screws. 2 months ago they were removed and I am now at the stage where I am coming to terms with the new shape of my foot!
I have 2 pairs of shoes that I fit now out of my extensive shoe wardrobe.. I pretty much live in sneakers, I have custom made orthotics that fit nicely into them.
The problem I have is that my midfoot region of my left foot is now very raised.. almost a little hill on top of my foot. Making it very hard to fit shoes. I saw my pod last night and he said it could be just scar tissue and it might go down in 6-9 months. I guess I was just wanting to know what else could be under there? Is it bone? And how close to normal might my foot go?
I had a bit of a nightmare not long ago because I was a bridesmaid and for the life of me could not find a shoe to fit my foot.
I am looking at strectching a couple of my boots, because I miss variety.. but don't know if I should.
Especially with summer coming up in my part of the world, it's hard to find a pair of pretty sandals that my foot fits and can also slip my orthotics into.

I have bookmarked this blog though, so I can have a browse of what shoes you suggest! Not sure if they deliver to NZ though!


Doctor of Podiatry Discusses and Recommends Shoes. said...

Hi Esther,

I'm really sorry to hear that you suffered such a serious injury! Don't despair! You will be able to wear nice shoes that feel great and look good.

An x-ray or even an ultrasound will verify whether the 'hill' is scar tissue or bone. If it is scar tissue there are some things that can help such as cortisone injections, which do have some associated risks with them so you need to discuss that with your Podiatrist. Also, physical therapy such as ultrasound treatments can helps to break up scar tissue. Also, you may want to use topical Traumeel cream, which is an safe, over-the-counter anti-inflammatory that will help take down some of the swelling and help with pain. If the bump is bone, the only real option is surgery to remove the excess bone, which I would leave as a last resort - especially after all you have been through.

Did you read my article entitled, "Shoe Recommendations for Patient's Recovering from Lisfranc's Injuries"? You can find it through the search box on my blog and it gives and A-to-Z recommendations for what to wear as you go through a typical day. Also, with tennis shoes, you can 'skip a lace' over the bump area to relieve the pressure, which should also decrease irritation so that it does not continue to enlarge.

It is so important that you never walk barefoot or wear flip-flops!

For shoe recommendations check out my articles "Top Twenty Comfortable Women's Sandals" and "Top Twenty Comfortable Women's Dress Shoes" and "Top Twenty Comfortable Women's Boots" for lots of ideas. it's important that you don't have any pressure on the 'bump' and, for boots, you can take the boot to a Cobbler to stretch the leather over the bump area.

For sandals - try the Wolky Cloggy, Tulip or Jewel or the Naot Paris or an Aravon sandal. For a casual boot, try a flat UGG that you can put your inserts into. I would highly recommend trying them on in the store to see how they feel.

For an exercise shoe - try the New Balance 928 with your inserts and skip the central lace for less pressure on the bump.

Good Luck and thank you for reading!!

Est said...

Thanks for your reply!

I may wait and see if my raised part does end up going down by itself, if in a few months it still isn't changing I might see if there is anything I could do about it. But I don't think I would put myself through surgery again!
I have started using Antiflamme, which has Arnica, Calendula, Hypericum and Peppermint in it. It seems to help relieve the surface pain I feel, and I think it is similar to Traumeel, after having a quick google.
I have had a look at your shoe links, and I think my only problem is finding stockists in NZ. Just last week though I ended up finding a shoe which is my compromise with a sandal. It is a closed lace up leather shoe (flat), so has all the support I need, but has holes through it for breathe-ability in summer. They were comfy straight away and because they have laces I could adjust them to my foot.

Your most recent post is a bit scary! I must confess I have more than once walked to the bathroom bare-foot, and since his injury sounds similar to mine I will be more careful in the future! That's crazy to think the screws broke!

I just had one more question, and I'm sorry it's not shoe related..you may not be able to help. I still have swelling problems which is to be expected. I have been wearing my compression stockings or Tubigrip (compression tube bandage) every day otherwise after 10 mins down my foot will be going a bit pinkish and itchy with the blood flow. I was wondering if you were aware of anything more permanent than Tubigrip for swelling? I don't know if i could be using sports strapping tape, or if there is a support available, any more permanent supports I find are for ankles up. It's mainly because I wear the Tubigrip to the gym and the elastic wears out fast, I seem to keep having to spend money on new ones. I work in a pharmacy and I have been looking at our stockists and they don't seem to have anything for me!
Thanks again for your help!

Doctor of Podiatry Discusses and Recommends Shoes. said...

Dear Esther,
I'm sorry for the delayed response! If you are getting persistent swelling, I would recommend possibly following up with a Vascular Surgeon for an evaluation. Also, make sure you are getting regular checks with you doctor as chronic ankle swelling can be related to heart problems.

I'm not sure I can improve on wearing compression hosiery and Tubigrip! Besides proper shoes, custom molded orthotics, compression hosiery, elevation and rest, over the counter anti-inflammatories such as ibruprofen - if they aren't working, I would recommend a follow up with a vascular surgeon for a consult.
Hope all is well!

Anonymous said...

Hi! Do you have any recommendations for some excellent Over-The-Counter Inserts for arch support?
Thanks and have a nice weekend!

Doctor of Podiatry Discusses and Recommends Shoes. said...

Regarding over-the-counter arch support, most Podiatry offices carry excellent OTC arch support. We carry 'Footsteps' which I personally think are the best OTC insert available. Our office carries them and they cost $50 so if you would like a set, call Callie (480) 563-5115 and she will be able to mail them to you, plus postage.

Other OTC inserts that I like are Powerstep, Super Feet (at REI), New Balance, Rocket Dog and also the sports Spenco, which you can purchase online.

Stay away from any insert that is simply gel. All they offer is cushion. What you need is firm arch support with cushion on top of it.

Hope that was helpful!


Shanaya said...

Excellent and helpful post.I am so glad to left comment on this. This has been a so interesting ..I appreciate your effort..