Monday, January 9, 2012

How "cruel" are your shoes?

I read a story written by comedian Steve Martin some years ago entitled, "Cruel Shoes." In this story, a woman goes to a shoe store to purchase shoes, and is not satisfied with any that are brought out to her by the salesperson until she finds a pair that are so uncomfortable that they contort her feet and make them bleed. When she tries these on, she is finally pleased, and decides to get them.

When I was younger, there were times when I walked all over BYU campus in heels, sometimes spiked, not all of the time, but at least once a week for a school year when we had church services in a building on the opposite side of campus from where we lived. I knew it wasn't good for my feet; however, I have short legs, and I thought wearing high heels made my legs look longer. Besides, I did not want to make myself look weird. So, I kept wearing them and put my feet up to rest when I got home.

In my late thirties to early forties, I noticed that whenever I wore high heels (as opposed to lower heels), my knees started to hurt a lot within 15 minutes. It was so bad that I could not stand, but had to sit down. They kept hurting for a while after I took the heels off. I stuck to low-heeled pumps for several years, until a few years ago, I could not even wear those. The bottom of my foot had started to hurt in addition to the knee pain. It felt like I was walking on the bones, with no cushioning at all. I had to stop wearing dress shoes completely. Also, there was only one style of athletic shoe that did not make my knees hurt, and the last time I went to get another pair, they were discontinued.

Thankfully, it was about that time that I found out about trigger point therapy. I worked the trigger points in my legs to help get rid of the pain. The pain in the knees came from my thighs, and the pain in the foot came from my calves. But the pain was quick to return when I walked for any length of time.

I learned that I have something called Morton's foot (not to be confused with Morton's neuroma), that is, I have a longer second metatarsal (bone behind the second toe) than the first metatarsal. This predisposes me to problems with my feet and indirectly causes pain in the rest of my body. This difference in metatarsal length made it so I was walking on two points of my foot, instead of three--kind of like walking around on an ice skate, but without the high top boot. The muscles farther up my body were working very hard just to keep me standing.

Fortunately, The Trigger Point Therapy Workbook had a fairly simple and inexpensive way to compensate for my foot structure (See p. 243). I cut out an oval or circle of moleskin about an inch-and-a-half in diameter for each foot. I stuck it (it is a peel-and-stick product) on the bottom side of a foam insert that had been cut to fit my shoe, in the area under the first metatarsal.
Foam insert, cut to size. 

Example of piece of moleskin attached to bottom of foam insert. 

I was amazed at the difference this made. I could actually stand tiptoe, something I had not been able to do for a long time. It eliminated my knee and foot pain (as long as I stick with low shoes). Putting the pad under the first metatarsal gives it a little more "length" so that it can hit the ground before the second metatarsal.  The first and fifth metatarsals, and the heel, act as a tripod to bear the weight of the body.

So, if you have ongoing foot pain, knee pain, or back pain, it might be a good idea to take a look at the bones that protrude when you bend your toes. (There is more information on p. 243-245).

To fit yourself with one of these "custom orthotics," flex your big toe upward and feel for the bony part in the center of the fleshy pad below the big toe.
Feel the bone in the fleshy pad below the big toe.  

Trim the circle or oval of moleskin to fit comfortably under that bone, without going under the bone that is further into the foot (the second metatarsal). Check where to place the pad* first (before you peel off the backing), then peel the backing off and stick it to the bottom of the foam insert. Then place the insert in your shoe. Mine usually last a month or two before the insert starts to wear out.

Also, consider the type of shoe that you wear. Clair Davies writes, "Wearing high heels keeps the soleus [this is a large flat muscle that wraps around the back of your calf] muscles shortened, which is a sure way to create and perpetuate trigger points. The ankle instability typically caused by high heels also strains the soleus muscles with each step." (p. 239).  Trigger points in the soleus can cause "deep pain in the sacroiliac area and maintain spasms in the muscles of the low back" (p. 238). It also sends pain to the back of the calf, heel of the foot, and inside ankle.

So, how cruel are your shoes?
*I have noticed that some people have a very large difference in length of the first and second metatarsal.  They may need to have a thicker pad to compensate.  Experiment a little bit to see what helps you.

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