Thursday, March 26, 2009

Should I believe the Orthotic Commercials?

Watching tv early Sunday morning, I saw an infomercial for the orthotics with the interchangeable heel piece so each person can adjust their insert to their foot. Later on, I saw a similar ad for a hi-tech computer force plate that you simply stand on in a pharmacy, and a computer will tell you what number insert you should buy for your feet from their store. The bottom line is, “what will make my feet feel better?”

For the person seeking relief from foot pain for the first time, I do not discourage trying one of these alternatives to traditional orthotics from your podiatrist. It is human nature to try the easy route before finally breaking down, months after the onset of pain when it becomes unbearable to work even for a few hours, and schedule an appointment to see a foot doctor. Sometimes, the problem is simple and can be relieved for a while by a plastic insert that you can buy from a pharmacy shelf. Other times, the right decision is to schedule an appointment with a trained specialist.

The Breakdown on inserts can become complex with so many varieties out there:

1) The insoles you will find in a pharmacy are little more than replacement sock-liners for your tennis shoes. They are flexible and offer little support. The gel insoles offer no support, but do offer cushioning for those whose natural fat padding has worn away.
2) The next level is an insole that you'll find in an athletic shoe store. These often have a plastic, graphite, or rubber shell that, while flexible, does offer support. Who are these right for? Anyone having minor to moderate pain in the heel, Achilles tendon, shin splints, or elsewhere in the foot should notice some improvement. If the pain is not significantly better in two to four weeks, a podiatrist should be consulted. A word of warning: These are generic arch supports that are appropriate for those with "flat feet." If you have a high arch, these insoles may make your pain worse.
3) And then there are the mall kiosks and shoe stores with their "experts" who have you stand on a hi-tech computer force plate to measure the pressures beneath the foot. Don't waste your money! First of all, a static footprint tells very little about how the foot functions when walking. Second, before you drop lots of money on something custom, be sure that the person has a degree and not just bought into a franchise.

For general foot pain, the product that I have found that works best for patients is the Powerstep brand orthotics. These orthotics were designed by a podiatrist and offer the extra support that you cannot receive from the pharmacy brands. You can find these products on the web at Amazon or at our website ( They should last 6-12 months depending on use. Custom orthotics are not simply arch supports; they are devices formulated to balance your feet, and entire lower extremity to allow them to function most optimally. Therefore, finding the right one can make all the difference to a person with painful feet and legs. If the pain persists or the condition worsens, you should call your local foot doctor, who will be able to assess your condition and fit you for the most appropriate shoe inserts.

If you have trouble seeing when you drive, you wouldn't solve it by buying a pair of one dollar reading glasses in the pharmacy, right? Why wouldn't you give the same consideration to your foot pain?

Monday, March 9, 2009

When to Replace Shoes?

From the mother of the 10 year old engaging constantly in active play, to the 80 year old diabetic patient who is largely inactive to the runner who runs 70 miles each week, everyone wants to know when they should purchase a new pair of shoes.

We all know that shoes do not last forever. Most people, however, continue to wear them well after their useful life has ended. Most commonly in my office I'll have people tell me that their shoes are three years old BUT (insert excuse here...). Some of my favorites, it fits my feet perfectly (meaning it's broken down), the heel is worn out just how I like it (meaning it has a hole inside the shoe), new shoes just bother me (meaning that I've worn these for so long, the support is too different at this point), and my favorite: They still look new.

Yes, they still look new. When all you do is run on the treadmill, use the elliptical, and some stationary bike, and your shoes never see the light of day, of course they look new. What's problematic is the part you don't see.

The support and function of a running shoe has little or nothing to do with the overall appearance of the upper part of the shoe or even the sole. It's the midsole, the portion of the sole that is largely invisible from the outside, which has the most function and limits the useful lifetime of a shoe. With every stride, the midsole compresses and, with time, loses the majority of its support. For runners, I estimate the useful lifetime of a running shoe at approximately 350-550 miles. For those who really don't run regularly, or participate in other sports and activities that can't be measured by mileage, your shoes should be replaced every 4-6 months, depending on the frequency and level of the activity.

So start keeping track of the life of your shoes. Dedicate a pair of shoes (or more) exclusively for exercise to get the most out of its useful life. Keep a tally of the mileage in your running journal, or even on the side of the shoe in pen. Write the date of the shoe on the tongue or the outsole of the shoe so you really know how old it is. You can check for signs of wear on the sole by placing your old shoes on a table and looking at them from behind. If the soles are worn and leaning to one side, the midsole cushioning is probably worn as well.

Other signs to look for in your aging shoes include:
• Look for creasing of the midsole material in areas of high load (under the heel or the ball of the foot). A worn out midsole will have wrinkles and creases there.
• Try to twist the shoe. A worn out midsole will allow the shoe to twist more easily than a new shoe.
• Try on a new pair of the model that you are currently wearing. Compare this to your current shoes. If the cushioning in your shoes feels dead in comparison, it probably is.

Just like the tread on your tires, you must constantly be looking for wear on your shoes. In your car worn tires may cause an accident, but we often overlook that injuries are much more likely in worn out shoes as well. Like tires, you can help prevent the normal wear and tear. By rotating your shoes daily between 2-3 pair, taking them off properly by unlacing them and removing them by hand and lastly having shoes dedicated to certain activities for example if you run, you would want to have a pair of shoes you use only for running, you can significantly lengthen the shelf-life of your shoes.