Monday's Image of the Week: Abnormal Heel Wear as a Sign of Gait Problems

As this patient walks, his right heel scuffs the ground terribly causing tripping and foot slap. This is a neurological problem related to his low back. It is seen primarily at the heel of his right shoe (on the left side of the image below). As a podiatrist, I am trained to look for clues in shoe inserts and shoe outer sole wear patterns. Usually the clues are more subtle. This patient was having major nerve problems in the right low back, and the nerves were not firing appropriately. 

Heel Pain: Try to Beat the Wear Pattern on these Orthotic Devices

The science of reading shoe inserts for pressure analysis can be as mysterious as reading the tea leaves for some, but not for experienced forensic podiatrists like myself. When this patient stated she was having heel pain, and found great relief from some orthotic devices she only wore occasionally, the wear pattern on the top covers shows the whole story. This may be a fitting blog post for the day the new Sherlock Holmes movie comes out. Can you see where the wear is? Probably more important, can you see the heels have had excellent pressure relief? Elementary my dear Watson!!

Shoe Inserts: Biomechanics Involved with Patterns

Quick Tip #2: Shoe Insert Patterns

You can learn a lot about someone’s biomechanics from looking at the shoe inserts they wear, especially in the most worn shoes. Can you tell which foot pronates (arch collapses) more? It is the right side since the material in the right arch is more worn. If the patient presented to the office with 2nd toe pain, which side would it probably be? Again, the wear pattern shows more pressure through the right 2nd toe area compared to the left.