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What Sad Tales Our Feet Tell

Pair of red stiletto heel shoes
These shoes weren't made for walking.

Podiatrist Dr. Russell Wojcik has been serving the greater North Hollywood area in his field for over a decade. Join LoveToKnow (LTK) as Dr. Wojcik answers our questions as to what ailments our feet suffer for the sake of fashion.

How Safe is Your Style?

(LTK) Since you have been working in the field of podiatry for so many years you must see a lot of shoe related injuries. Overall, what are the most common footwear related ailments your patients experience?

The most common ailments seen are hammertoes, bunions, corns and calluses.

(LTK) The stiletto type heel is highly venerated in the fashion industry. In fact, it has been claimed that high heels can actually aid the appearance of good posture. However, in your opinion, are stiletto heels a medical concern?

Stiletto heels continue to be a medical concern today, as they will be tomorrow. As you say, "high heels can actually aid the appearance of good posture." There is a difference between good posture and the 'appearance' of good posture.

Stiletto heels tend to alter the center of gravity forward (from the hips down to the foot) and then compensate by arching the back, thereby creating a mild lordosis of the spine by shifting the center of gravity back (from the spine to the shoulders) to its original position. In a normal posture person (without stiletto heels), the center of gravity falls just behind the ear, slightly in front of the shoulders, and downward to just behind the hips (over the ischeal tuberosity of the pelvis, directly over the knee and ankle, and ending at the rear foot (directly over the talo-calcaeal articulation).

By altering the center of gravity, the body has to compensate in order to bring the center back in line. As result, there begins an overuse of muscle groups, abnormal weight bearing on joints, and generalized muscle fatigue leading to cramps--- all of this transfers into aches and pains. Over a longer period of time, these aches and pains then transfer over into bony enlargement, mal-alignment, and generalized bone pain.

If somebody MUST wear a stiletto heel, I would hope that the heel is no longer than 2 ½ inches. Once somebody goes 3 inches or above, they are asking for foot problems to occur in a few years.

Sports and Shoes

(LTK) Let's talk about athletic shoes. What sort of shoe related injuries do you find in your sports-injured patients such as marathon runners, cyclists, basketball players?

I can't speak for cyclists because I just haven't seen any in my practice to date. Marathon runners present a variety of problems of which some are due to inadequate conditioning, warming up (before a race) and icing down (after a race). Runner's shoes have made great strides over the past 10-20 years, with much thought of foot function being built into the shoe. Unfortunately, the problems I see in runners may be those due to the type of surfaces they run on rather than the shoe. A concrete surface will produce more wear and tear on the foot that that of an asphalt, or dirt surface. The conditions that seem to be the most prevalent in runners are shin-splints, plantar fascitis, metatarsalgia, and blisters.

In basketball players, the most common aliments are metatarsalgia and ankle sprains. The prevalence of ankle sprains says something about bringing back the high-top shoe for ankle stabilization, or hopefully, it spurs on attention to the incorporation of a light-weight ankle brace into a high top shoe.

(LTK) What advice would you give athletes in regards to selecting appropriate footwear?

As with any shoe, the emphasis is placed on proper fit as to length and width. Lengthwise there should be anywhere between ¼ to ½ inch between the end of the big toe to the end of the shoe.

However, there is an exception: if someone has a Morton's foot (short 1st metatarsal), it is best to measure the length between the heel and the ball of the foot rather than the heel and the end of the big toe. The widest part of the shoe should match the widest part of the foot, usually the side of the "ball" of the foot.

In addition, you should be able to produce a slight pinch with excess shoe material between your fingers. If you cannot, then the shoe may be too narrow. The heel counter (cup around the heel) should fit snugly yet not be so stiff as to cause irritation. A loose fitting counter can cause blisters or possible tendon irritation from excessive motion. The vamp of the shoe (the part that covers the forefoot) should be wide enough to accommodate the forefoot without being too tight (causing corns, toe deformities, and cramping of muscles).

The toe box should allow free movement of the toes without pressure. Try to stay away from toe boxes that slope forward as these can cause irritation to the nails (subungual hematoma) and the digits themselves (abscess formation over the digital joints). Also, make sure the shoe has a firm arch support built in and cushioning of the ball of the foot and flexibility of the front sole for easy push off.

(LTK) What about dancers? What sort of shoe-related podiatric ailments will you see in, for example, a ballerina who wears pointe shoes regularly?

What ailments I have seen in ballerinas or dancers are those that arise from forces placed upon the toes and forefoot. Over a period of time, these forces produce mallet and hammertoe deformities. Also, there occurs bone spur formations (from abnormal pressure forces on the bone), especially around the joints that will begin to limit its motion. In the forefoot, we sometimes see a deviation leading to instability of the metatarsal joints. This usually results in one of the metatarsal bones dropping downward with a migration or loss of natural fat padding to the bottom of the foot. This can give rise to thick, deep-seated, callous formation

'''(LTK) When purchasing shoes, what are the most important concerns concerning foot and ankle health?

There are two thoughts to keep in mind:

  1. A proper shoe should provide support and cupping of the heel, a firm arch support, protection of the ball of the foot, and flexibility of the front sole for easy toe-off when walking.
  2. Shoes are for protection, support, traction, and cushioning from a hard surface.

(LTK) Do you deal with many diabetic patients who require special footwear? What apprehensions and/or notable advice do you have for diabetics when it comes to choosing safe shoes?

Diabetics are a group who require special footwear, especially those who are high risk as a result of poor circulation, sensory perception (neuropathy), previous amputation, frequent infections, and corns and calluses that go into ulcers. In response to this need, there has been the emergence of several diabetic shoe manufacturers. Dr. Comfort, Sure-fit, and Natural Step are three that come to mind.

What makes diabetic shoes special is that they are considered extra-depth shoes which allow for inclusion of super-soft inserts (plastizote heat moldable) that helps to cut down on friction and pressure forces to the bottom of the foot. In addition, these shoes are made of soft quality leather that "breathes" (allows for exchange of gasses from outside the inside the shoe), and the shape actually accommodates the foot without impinging the toes, midfoot, or heel. Besides laces, these shoes come with the option of Velcro straps for those who are unable to tie their shoes (i.e. rheumatoid arthritis, peripheral neuropathy, fibromyalgia).

A few years ago, Medicare instituted the Diabetic Shoe Program for high-risk diabetics in an effort to stem the rate of diabetic foot complications leading to amputation. This program allows diabetics (those 65 and older) to get one pair of these diabetic shoes (with inserts) each year. Most of these diabetic shoes are sold through podiatrists or pedorthists, so that the patient is reasonably assured of a proper fit as to length, width, and special accommodations, if any.

Hopefully, most diabetics are under the care of a doctor (D.P.M., M.D.) for their foot care. My recommendation is that the patient take the time out to ask their doctor what shoes would be preferable for them to wear. Depending on the patient's condition of their feet, and their diabetic control, the doctor would be able to advise them whether they can go with store-bought shoes or would they be better off with diabetic shoes.

A Podiatrist's Picks

(LTK) Are there any particular shoe brands that receive your professional recommendation?

Yes, for the women, I have been impressed with the Easy Spirit and SAS line of shoes. I'm sure there are others out there that are just as good (i.e. Naturalizer), but the Easy Spirit and SAS shoe seem to have all the qualities we previous mentioned built into their shoes. Their styles are many, but their overall shape is not off the wall. It is a somewhat rounded shoe fitting a somewhat parabolic shaped foot.

For the men, three makes quickly come to mind: Ecco, Rockport, and Bass. I am particularly fond of Ecco shoes, because they have an insert that can be pulled out and have an orthotic inserted for enhanced foot control within the shoe.

What Sad Tales Our Feet Tell