Front of the Foot Pain: Email Advice

Hi

I've getting very desperate, because nobody is able to tell me what is wrong with my foot!

One doctor said it was a neuroma, so he gave me 3 cortisone shots, and it didn't work. Another was honest enough to say he has no idea, so he sent me to therapy.

What I've noticed is that on my left foot, I seem to land on the outside of my foot when I'm walking. However, it only seems to happen when I am wearing foot wear. ANY footwear. Tennis shoes, flip flops, or ballet flats.

When I'm barefoot, it seems to not be a problem.

This seems like supination from what I've read in your blog. But why is it only an issue if I'm wearing shoes?

Thank you so much in advance for the answer. I've had this problem for at least 6 months, and it seems to be getting worse :(

Regards,

Dr Blake's Response:

     Thank you for the email. Shoes typically take you more a more flat footed position to a more supinated position in a normal to pronated patient, and the opposite for supinators. Of course, if shoes place you right on where you are sore, you need an orthotic interface between the foot and shoe to make off weighting changes. That is normally attempted in athletic shoes first, dress second, sandals with removable inserts third. Flip flops if they are causing you problems need to be avoided until the inflammation is calmed down. 

     What to do now? It seems like you need some testing, like xrays and MRI, to analyze the problem. A second opinion may be good, but that does not mean you have to switch. Try to create your own pain free environment analyzing the best foot wear at this point. Experiment with various OTC inserts to see if you can discover what protects your foot the best. Ice your foot for 10 minutes 3 times daily to reduce any inflammation. 

     You can send photos pointing to where the pain is. Try to send me 10 bullet points on the type of pain you have. Am only? Sharp? Aching? Radiating? What helps? What hurts? etc, etc. Hope this points you somewhat in the right direction. Rich

Shoe Design: Where Should a Shoe Bend When We Push Off??

Video on Shoe Flexion Testing (Creating Flexibility When Needed)

Classic Shoe Flexion and Shoe Torsion Tests 

Here is the bottom of a running shoe with multiple cuts or striations that allow for shoe flexibility as you roll up onto the ball of your foot in push off or propulsion.

The pink material demonstrates where the ball of the foot should bend the easiest in your shoe flexion test. The multiple striations make it easy to accomplish the bend needed.

Here is a shoe where the bend is not only in the wrong position but the cuts or striations do not go all the way across the shoe. The bend of course at the big toe should be the greatest, yet in this example their is no attempt to allow for this bend.

There the pink material shows where the shoe should bend, yet it lies between the two striations!! The bend at the ball of the foot should be even with the big toe joint (widest part of the foot/bunion joint), and then slightly go back towards the arch as you near the baby toe side.

And, just for fun, here I am demonstrating a rocker shoe that is not meant to bend at all. You are encouraged to roll right on through and you should not attempt to push off.