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Thursday, August 23, 2012

Podiatrist Shoe Recommendations For All Day Comfort At Work.


Dr. Cathleen A. McCarthy

After I completed my first two years of Podiatry school where I basically sat all day in classes and then went home and spent more time sitting and studying, I was unceremoniously tossed into my third year where I was expected to stand on hospital floors for ten to twelve hours a day.
To make a long story short: I was in agony!
I finally understood why all those lectures on ‘Heel Pain’ were so important – and relevant! Throughout the third year, I had a recurring nightmare where I would wake up in the middle of the night convinced that an evil ogre was hammering a nail straight up into my heel and I desperately tried various kinds of shoes – searching for that illusive, magical shoe that would help me get through the day comfortably. 
Ironically enough, even though I was in Podiatry school, we spent most of our time learning surgery and medicine but I don’t remember a lot of lectures on what constituted a ‘good shoe’. Our professors did talk about advising patients to wear ‘good shoes’ but few ever specified exactly what that meant.
Once in private practice, I began to realize what a crucial role proper shoes play in a helping patients get better faster. I also realized that what works for one patient may not necessarily work for another patient with a very different foot issue. In other words, proper shoes for patients are pathology specific and depend on the patient’s biomechanical foot structure as well as history of previous problems and injuries.
I came up with some basic rules for picking comfortable shoes for all day wear on concrete floors and, although there are always exceptions to the rules, these rules work for most patients.
First, you should always look for a shoe with a thick, rigid sole. This is counter-intuitive because most people look for a ‘soft flexible’ sole thinking that it will be more comfortable. In reality, it’s the exact opposite! You need a thick, rigid sole with less motion and less flexibility so that it is more protective of the foot joints, muscles and tendons. Think of it this way, if you broke your wrist, your doctor would put you in a cast and you would instantly feel more protected and have less pain. Less motion equals less pain. 
Second, you should try to find a shoe with good arch support. Most shoes come with removable insoles so that you can replace it with either a custom-molded insert or an excellent over-the-counter insert that offers arch support. Ninety percent of people will benefit from arch support while ten percent of people cannot tolerate arch support. Proper arch support can help with knee, hip and lower back pain and decrease ‘tired-leg syndrome’ at the end of a long day on concrete floors.
Third, you need a wide, soft toebox. Avoid any shoes with pointy-toes as they can cause hammertoes, bunions, corns and calluses.
Forth, make sure that whatever shoe you choose has proper rearfoot control. In other words, your shoes should have no open backs. If your shoe doesn’t have rearfoot control, you are forcing your tendons, muscles, knees, hips and lower back to work harder to keep your foot in your shoe. This causes more ‘mechanical strain’, which leads to increased discomfort and chance of injury. 

Here are some specific shoe recommendations that are pathology specific:
For the young, healthy person with strong legs and no significant foot or ankle deformities, I would recommend the Dansko or Sanita Clog with rearfoot control.
For a young, healthy person with no history of balance issues, Achilles Tendonitis, nerve damage or weak legs, I would suggest you try the MBT, Sketcher-Shape-Up or the New Balance Rock and Tone shoe. Each of these are ‘rocker-bottom’ shoes, which can be extremely comfortable. I do recommend that you wear arch support with these shoes – whether it’s custom-molded or over-the-counter inserts.
For a person who may have more serious foot issues such as diabetes, nerve damage, balance issues or weak legs, I recommend trying the New Balance 928, which is an extra-depth shoe with a thick, rigid sole and a wide base. If you have trouble reaching your feet due to hip and knee replacements, you can get the NB 928 with Velcro-strapping. I highly recommend that if you do have these more serious medical issues, please consult your Podiatrist to make sure this shoe is right for you.
For virtually anyone, try the Crocs Rx clog and make sure to wear the strap to the back so that you get some rearfoot control. These are not for everyone but there is a reason why you see so many nurses and doctors in Crocs!
Let’s not forget the guys! For the man who is on his feet all day in tough conditions, my personal favorite is the p.w. Minor Hercules, which is an extra-depth boot with a hidden shank in the sole that is very protective and comfortable.
I hope this has been helpful!


Dr. Cathleen A. McCarthy

Monday, August 13, 2012

Comfortable Women's Wedge Sandals...


Gentle Souls - Juniper Barry Red 

Gentle Souls Dolling

Juicy Couture Mallory Too Flat

What's great about these wedges is that they give you the height (for fashion) but they don't give you the excessive 'foot tilt' forward, which makes for more comfortable wear and puts less strain on the joints, muscles, tendons as well as the ball of the foot. Each of these wedges has strapping of the forefoot, midfoot and rearfoot, which offers more biomechanical control and therefore allows for more comfort, less mechanical strain and less chance of injury. 

These Wedges Should Be Comfortable For Patients With:
*Mild to Moderate Hammertoes
*Mild to Moderate Bunions
*Mild to Moderate Tailor's Bunions
*Mild Metatarsalgia
*Mild Hallux Limitus (Limited Range of Motion of the 1st Toe Joint)
*Mild Osteoarthritis
*Mild Capsulitis
*Mild Morton's Neuroma
*Mild Heel Pain
*Mild Achilles Tendonitis
*Mild Tendonitis   
*Mild Over-Pronation 
*Dorsal Exostosis (Bone Spur on Top of Midfoot area)

These Shoes Are NOT Recommended For Patients With:
*Moderate to Severe Hallux Limitus (Limited Range of Motion of the 1st Toe Joint) 
*Hallux Rigidus
*Moderate to Severe Osteoarthritis
*Moderate to Severe Degenerative Joint Disease
*Rheumatoid Arthritis
*Peripheral Neuropathy (Nerve Damage)
*Peripheral Arterial Disease (Poor Circulation)
*Weak Legs
*Balance Issues
*Drop Foot
*Charcot Foot
*History of Ulcerations 
*Hypermobility / Ligament Laxity
*Moderate to Severe Over-Pronation

I hope this was helpful!


Dr. Cathleen A. McCarthy


Saturday, August 4, 2012

Podiatry Review of the John Fluevog Hi Wedge Dawn & Prepares Merit...

John Fluevog:

A Review of 

Two Fabulous High Heels

For Women Who Know They Can Wear Heels! 

John Fluevog Hi Wedge Dawn

Be still my heart! 
I love John Fluevog shoes and I adore the look of the Hi Wedge Dawn.
I personally am on the verge of not being able to wear heels this high anymore because of the biomechanical structure of my foot 
(mild Hallux Limitus with a slightly elevated 1st metatarsal and the beginning of a dorsal 1st metatarsal-medial cuneiform exostosis - but I digress...)
If you know that you can comfortably wear high heels, this is a good choice for comfort and style and I will be watching with admiration from the wings (in my lower heeled shoes).

John Fluevog Prepares Merit 

Perhaps it's the Aquarius in me, 
but I totally dig this!
(Sorry, my seventies are showing...)
The heel takes a bit of getting used to but, once again, if you know that you can comfortably wear heels, this is another good choice for style and comfort. Because the heel height is lower than the Hi Wedge Dawn, this will be the better choice.

The Good, the Bad & the Fabulous...

What makes both of these shoes so comfortable is that they have a thick, rigid sole that allows no motion across the bottom of the foot, 
which significantly decreases mechanical strain of the joints, tendons and muscles and allows for more comfort. Both heels have a wide and relatively soft toebox that allows for more accomodation of mild to possibly moderate bunions and hammertoes. They also have excellent midfoot and rearfoot control and, in the case of the Hi Wedge Dawn, excellent ankle control.  
Anytime a shoe can 'lock in' the foot and ankle structures, you get more 'biomechanical control', which means: 

*More Comfort

*Less Chance of Injury

*Less Wear and Tear of the foot structures

*Slowing the progression of foot problems such as bunions and hammertoes

*Less strain on the knee, hip and lower back

Am I saying that these heels better than wearing a good walking shoe? 
No way.
But, if you are going to wear heels and you know can wear heels comfortably -
these are a good choice. 

When it comes to wearing heels, 
I always caution patients to listen to their bodies! If you are having any discomfort, then these are not the shoes for you. 
If any shoe causes you pain - don't wear them. Pain is your bodies way of warning you of a problem.
If your shoes hurt, you are straining something and doing damage!

Remember, it's your feet against a lifetime of all the concrete in the world so, no matter what shoe you choose, try to choose a shoe with a these four things:
*Thick, rigid sole for more protection
*Arch Support
*Wide, soft toebox
*Rearfoot Control 
Another thing to keep in mind is that 
choosing the right shoe depends on the biomechanics of your feet. 
That's what this blog is about. 
For example, a rocker-bottom shoe is great for most people with plantar fasciitis (heel pain) but I would never recommend a rocker-bottom shoe for anyone with Achilles Tendonitis as it can cause the condition to worsen.

With that in mind...

The Hi Wedge Dawn Should Be Comfortable For Patients with:
*Mild Plantar Fasciitis (Heel Pain) 
*Mild Hammertoes
*Mild Bunions
*Mild Achilles Tendonitis
*Maybe Mild Over-Pronators (Try wearing a dress orthotic specifically made for dress shoes to give you some arch support. Your health insurance might cover orthotics so ask your Podiatrist's office if they will check with your insurance to see if it is a covered benefit. If it is not a covered benefit, most Pod offices will carry an excellent OTC insert for dress shoes that are significantly less expensive). 

The Prepares Merit Should Be Comfortable For Patients with:
*Mild Plantar Fasciitis
*Mild to possibly Moderate Bunions 
*Mild to possibly Moderate Hammertoes
*Mild Achilles Tendonitis 
*Mild Metatarsalgia
*Mild Morton's Neuroma
*Mild Forefoot Capsulitis
*Possibly Mild Sesmoiditis 
*Mild Tendonitis
*Mild Tailor's Bunions 
*Mild Corns & Calluses 
*Mild to possibly Moderate Over-Pronators (try adding a custom-molded orthotic or over-the-counter insert made specifically for dress shoes or an less expensive over the counter dress insert for more arch control) 
*Mild to possibly Moderate Hypermobility (add an insert if needed)
*Someone who has had a previous Lisfranc's Injury but is healed and having no pain (If unsure, check with your Podiatrist)

These Shoes are NOT Recommended for Patients with:
*Moderate to Severe Hallux Limitus (decreased range of motion of the 1st toe joint)
*Hallux Rigidus (No motion across the 1st toe joint)
*Severe Bunions 
*Severe Hammertoes
*Degenerative Joint Disease
*Rheumatoid Arthritis 
*Severe Over-Pronators
*Severe Ankle Instability
*Severe Hypermobility  / Ligament Laxity
*Exostosis ("bumps" or "bone spurs" on the top of the midfoot area)
*Peripheral Neuropathy (Nerve Damage)
*Peripheral Arterial Disease (Poor Circulation)
*History of Ulcerations or Open Sores 
*Charcot Foot
*Weak Legs
*Moderate to Severe Knee, Hip & Lower Back Problems/Pain
*Balance Issues
*The Elderly

I hope this has been helpful and I thank you so much for reading!

Have a great weekend...

Dr. Cathleen A. McCarthy