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.

Trigger Points in the Lower Legs-Working Your Calves

This is from a post that I drafted on October 21st, but I am finally getting it posted.

I've been focusing on working my calves for the past few days, and it is amazing what a ripple effect it has.  I feel more flexible and lighter on my feet.

Trigger points in the lower leg can send pain to the foot, the lower leg and up to the lower back.  If you have had back pain that has not responded to other trigger points, you may want to check your soleus muscle in the back of your lower leg (See p. 239 in the Trigger Point Therapy Workbook.  You can also click on the trigger point map link in the right column of this blog.)

The soleus is a very broad muscle that covers the upper two thirds of the back of the leg.  Much of the soleus is covered by the gastrocnemius which is a very thick muscle that has two branches.  The gastrocs (that is what I will call them--I have no idea if this is a typical term) form the part of the calf that bulges out in the back.  The Tibialis Posterior, Flexor Digitorum Longus and Flexor Hallucis Longus are narrower muscles that are located under the soleus and gastrocs.  (See pp. 234-243 in The Trigger Point Therapy Workbook for diagrams and details.)

It takes a lot of strength to work these muscles because of the thickness of the outer muscles and their location on the back of the leg.

There are several ways to work the lower leg muscles.  It is tempting to use your fingers, but you can soon end up with sore fingers, arms, and shoulders.  Another way is to lie on your back, or sit up, and rest one calf on the knee of the opposite leg.  By sliding the top leg back and forth, you locate the trigger points.  When you find a trigger point, massage it by pressing your leg in a little deeper.  This is effective, but can get quite exhausting, particularly for your quads .

If you are lucky enough to have an older armchair that has solid wood in the arm instead of cardboard, you can sit in the chair, place a lacrosse ball on the chair arm, lift up your leg and move your calf around on top of the ball.  This can also be quite effective.

I have recently come upon an idea that is working well for me, so I will share it with you.

Lie down on the floor next to a bare coffee table or side table.  Place a lacrosse ball on the table and place your calf on top of the ball.  Move your leg around the ball and work trigger points as you find them.

If you need to push a little harder for some of the trigger points, bring your opposite ankle over and rest it on top of the ankle of the leg you are working.   This takes the least effort and is the most effective of the ways I have tried to massage my calves.

Some of you may not be able to get down on the floor to do this.  I know that I would not have been able to get on the floor when I first started doing trigger point therapy.  One idea is to get a lightweight table (like the LACK side tables that IKEA sells for around $10). If your bed has enough room, place the table on one end of the bed and you can do the same procedure while lying on your bed.  You can also place the table in front of a chair and do the procedure that way, but you may not have quite as much leverage.

You may have something else that works for you around your house already.  The idea is to make working your calves as easy as possible.

One note.  The ball may roll off the table from time to time, especially when you are first learning.  It is mildly annoying, but easy enough to put back up.  It is easier to control the ball if you have bare legs, or fairly snug pant legs, since there is a tendency for it to get entangled in your pant leg.

I won't go into detail for each muscle in this post, but just to get an idea of what types of symptoms are caused by or contributed to by your calf muscles:  calf cramps; pain in ankles and calves, on the bottom of the foot, Achilles tendon, back of ankle, in long arch of foot, back of thigh, knee, inner ankle, outer side of heel, heel; hard to straighten knee; deep pain in sacroiliac area; spasms in lower back; hypersensitivity to touch in lower back; pain in jaw, knob of inner ankle; plantar fasciitis pain; low blood pressure; unexpected fainting; posterior compartment syndrome; circulatory problems; pain in metatarsal arch, undersides of toes, under the big toe, head of first metatarsal; numbness underside of big toe; cramps in the bottom of the foot; contribute to hammertoe and claw toe.  (Take a breath here!)

In later posts, we will address some of these more specifically.