Foot Pain, Foot Function, & Shoes

My personal health issues, combined with frustration with lack of results using the current common answers, continually take me to new and interesting places. In the past year most of what I know about metabolism, nutrition, and now feet (and foot pain) has shifted drastically. It all comes back to evolution.

I’ve had intermittent stabbing pain for about 7 years, focused at the 1st MP joint (where the big toe joins the foot). I walk a lot, and the more I walked, the more it hurt. It had been diagnosed as a stress fracture years ago, and and for years I would wear Danskos* (hard soles, so my feet didn’t flex) when the pain got bad. Basically the Danskos acted as a walking boot. I am heavy (180lbs, due to muscle and bone from my bodybuilding days, plus all the extra padding I’m currently carrying) and have small feet and a stompy gait… It just refused to heal.

The foot pain had been interfering with my workouts, but it was getting worse and now messing with my weekend fun, too … that’s no good! So I started investigating and it turns out the solution was simple. I didn’t have a stress fracture at all.

diabetes_foot_problems_s13_hammertoesWearing tight shoes, especially heels, can cause bunions (angled big toe), neuromas, and hammertoes (bent toes), too. Fortunately my problem was easier to fix than the poor feet in this stock photo!

I had to change my shoes.

That wasn’t all of it, of course – I also needed some fascial adhesions stripped out. Acupuncture reduced the pain and swelling, and the minimal shoes I transitioned into have had the cool side-effect of forcing me to soften my gait. I wear CorrectToes spacers when I remember. Still, changing the shoes was key . Shopping guide here.

Rolfer Karin Edwards-Wagner does a lot of work with feet, and she pointed me towards the brilliant Dr. Ray McClanahan. He’s got a bunch of videos and articles on his site, so rather than reinventing the wheel I’ll just let you look at his stuff.

Here’s the deal: See those bones on the top of your foot? Your toes should extend in a straight line from them. For centuries we have crammed our feet into shoes that gathered the toes together, creating a sleeker pointed look instead of the spread “duck-foot” that nature intended.

Available here in the office, Correct Toes spacers help separate and flatten your toes into a natural spread for better stability. Use them along with changing your shoes, and getting some acupuncture and medical massage to break up fascial adhesions and relax the muscles of your feet. Your knees, hips, and even lower back will be happier once your gait is correct!

ct-before-during-after__smCorrectToesLogo_small

 

Under your big toes are tiny floating bones called sesamoid bones, which provide leverage and assist in tracking as a tendon moves over bone. The knee cap is a sesamoid, too – in fact you can imagine a miniature knee cap under that joint in your foot. The bones have grooves that the sesamoids are supposed to follow. If the toe angles inwards, the bone is pulled off track. Ouch!

The funny thing here is that my feet look pretty “normal.” I don’t have bunions or any obvious deformation… just a few degrees was enough to cause that foot pain for me. I haven’t worn heels for years. Even so, I had a huge pile of shoes and boots (some of them practically new) that I had to sell, donate, or toss. The trick is finding shoes that:

1)   Have flexible soles across the ball of the foot and also longitudinally, for twisting.

2)   Have the heel at the same level as the toe. Now that I’m used to “zero-drop” shoes, even a half-inch heel feels weird.

3)   Fit well in the heel and instep, but have lots of room in the toebox. This is why regular “wide” shoes don’t work for me – the rest of my foot isn’t wide. See the pic below.

4)   Don’t have a lot of  “toe spring” – that’s when the toe of the shoe comes up off the ground. It pushes you into an unnatural position all the time.

Standing (with all of your weight) on the bottoms of the soles of shoes is a good way to assess how much room you’ll have. For boots, you can take out the inserts and stand on those instead. If your favorite shoes are just a smidge too tight in the toe box, you can remove the inserts, which gives you a few more millimeters of room to stretch out.  If they are lace-up shoes, skipping the first set of holes can also let the toe box open up.

No more foot pain! See how the medial (inside) edge has a square-ish corner, instead of being rounded? Wide at the ball of the foot isn't enough - that big toe needs to be able to move and spread outwards. These are my new favorites, Clark's "Faraway Field," available in other colors if you aren't into blue suede shoes. :)

No more foot pain! See how the medial (inside) edge has a square-ish corner, instead of being rounded? Wide at the ball of the foot isn’t enough – that big toe needs to be able to move and spread outwards. These are my new favorites, Clark’s “Faraway Field,” available in other colors if you aren’t into blue suede shoes. :)

The sad truth is that most of the anatomically correct footwear out there is hideous, but I have found some cute options! Shopping info here. My winter boot review is here.

In addition to going shoe shopping, I also got some socks! The regular “mitten” sock can encourage toes to gather together, especially if they get pulled tight as you slip into your shoe.  When I wear those, I stretch out the toe seam to give myself some room. Sock Dreams is a fun local company that carries a variety of toe socks, and they ship for free.

Can’t give up the heels due to work or your fashionista status? Check out this article on ways to mitigate the effects of high heels. 

So… the real question is, did it work? My emphatic answer is YES! A week after switching, for the first time I finished a LARPing weekend without being in agony. My foot and knee may have grumbled a few times (I run for miles during these weekends) but that searing pain was gone. At the end, instead of waiting miserably for Robert to be done cleaning, I was out doing extra trash sweeps, because I felt that good!  Plus, at my next workout, I had to ask Brandie to throw extra weights on for the leg extensions and squat press, because the weight we were doing before suddenly felt ridiculously easy. Correcting my foot function helped my knee normalize, too, which is a bonus I hadn’t expected. It makes sense, though. If the toes can spread out and do their job creating stability, it takes a lot of pressure off the knees.

The next adventure is the perfect intersection of SCA / LARP / craftiness, and healthcare: I’m going to try making my own shoes!

 

*Setting aside the issue of the heel height for the moment, it’s true that Danskos and other hard clogs make it easier on your feet. The trouble is, they make it too easy. It was obvious once I thought about it…

When a patient comes in with a brace (on the wrist, knee, back, whatever), we always have this discussion: “Immediately after an injury, a little support is very helpful. As you heal, though, you need to wean off the brace. It’s good to wear it for sports, or challenging events, but not all the time. If you baby the muscles, they won’t work and get stronger, which is what you really need to heal. Eventually you should be brace-free.”

I’d been over-bracing my feet. *headdesk*

Wearing softer, more flexible shoes that allow / force my feet to get to work makes them stronger. Here’s a cool exercise you can do to strengthen your feet. I still prefer some shock absorption when walking on man-made surfaces like concrete, but for dirt and carpet I like to go more minimal. 

What about arch support? Modern shoes actually give us TOO much support, so our foot and leg muscles don’t work, and get weak. Remember we evolved without shoes. Our feet are designed to support us, given the chance. By doing foot exercises and gradually transitioning to more minimal shoes, your arch will support itself. This is awesome because it means your feet take a lot of the load back from the ankles, knees, and hips in terms of balancing. The whole body works better when strong and supple.

Now that I have spent some time opening my feet up, I love the thin toe-separated shoes like Vibram 5 fingers. Just ease into them… minimal footwear takes some transition if your feet have been over-supported in regular shoes. I have a pair of Filas that are similar (just have shorter toes, so they fit me better) and I adore them! They are phenomenal for running around in the woods.

EDIT 7/1/13: Here’s an awesome article on another reason to wear good shoes – neurological challenge! Also – I get asked about foot pain due to Morton’s neuromas and plantar fasciitis (inflamed fascia) a lot. YES, I can treat them! The good news is that the treatment is immediately and highly effective. The bad news is that it’s the only treatment I do that hurts… Sorry. But only briefly, and it’s worth it, speaking personally!

Toenail Fungus: Prevention and Treatment

 

Mild case of toenail fungus.

Mild case of toenail fungus.

Severe case of toenail fungus.

Severe case of toenail fungus.

 

 

 

 

 

 

 

 

Thanks to the warm weather, more people are letting their feet breathe by wearing comfortable sandals and flip-flips. And with all these toes out for a walk, I’m seeing a lot of toenail fungus. Some sources claim as many as 12% of us are affected. You might have it, too! Are your nails thick? Yellowed? Crumbly? What starts as a mild case on one big toe can spread to all ten digits, and eventually deform your nails. I see it on hands, too, but not as frequently.

To prevent an infection of toenail fungus, thoroughly wash and dry your feet daily. Use only clean cotton socks, and don’t wear the same pair of shoes two days in a row (this lets the insides dry completely). In wet common-use areas like a sauna or gym shower, use shower shoes to prevent exposure. Definitely treat your feet to an extra scrub after your dip in a public pool or hot tub. If you go for professional pedicures, you should bring your own tools (running them in the dishwasher before and after to keep them clean) to prevent picking up an infection from another client. If you are prone to toenail fungus, you should forgo polish. Fungus actually lives on the dye of the polish, according to a podiatrist friend, so use a clear coat as a base.

If you are already infected, don’t worry. Just follow the above hygiene rules, and add in a twice-daily anti-fungal treatment. Lamisil is a popular over-the-counter topical product. Vicks Vap-O-Rub works well, too, because toenail fungus dislikes an acidic environment, and the vaseline base makes it stick to the area. Apply it morning and evening, after a thorough wash and dry, then cover with clean white socks. In 6-8 weeks you should see healthy nail growth.

People who prefer the “natural” route can use tea-tree oil or vinegar, but be aware that the treatment can take months. Severe cases should ask their doctor for prescription medication. And of course, acupuncture to help boost your immune system is a great idea, too. :)

Cheddar Almond Crackers / Grain free crust

This is a remarkably fast, easy and versatile recipe using cheddar cheese and almond flour. You can make grain free crust (for pizza or savory pies), crackers, & biscuits.

The first time, I used Bob’s Red Mill almond flour and a sharp yellow cheddar. I rolled the dough into a flat, compressed sheet, and got a Cheezit-style cracker.

The second time, I tried a coarser almond meal (from Know Thy Food’s bulk bin) and a mild cheese. I threw in some rosemary, and didn’t roll them as heavily, and they made sort of a cross between a cracker and rustic biscuit. I found an identical recipe online that called for dropping fluffy dough balls onto a cookie sheet to make biscuits reminiscent of Red Lobster’s Cheddar Bay Death Traps… but of course a much healthier version. I need to try that!

 

grain free crust and crackers

Rustic rosemary crackers: These were so stupendously satisfying and filling we dubbed them “Lembas Bread.”

These are by no means low-calorie, but they are higher in protein than regular crackers and are fine for the occasional indulgence. I plan to use this recipe for a savory grain free crust when I make beef & spinach pies for LARP this weekend. Come back for an update on how that went next week!

Cheese Crackers with Almond Flour (Gluten Free)
Modified from The Gluten-Free Almond Flour Cookbook by Elena Amsterdam. This recipe is half the amount in the book, so double it and make the full recipe if you prefer.

1 1/4 cup blanched almond flour
1/8 tsp. sea salt
1/4 tsp. baking soda
1/2 cup freshly grated cheddar cheese, lightly packed into measuring cup
1 1/2 Tbs extra-virgin olive oil
1 large egg

Preheat oven to 350F/175C.
In a medium-sized bowl, combine almond flour, salt, baking soda and cheese. In a smaller bowl, whisk together the egg and oil. Pour the egg mixture into the dry ingredients and stir until well-combined.

For crackers: Cut two pieces of parchment paper the size of your baking sheet. Put one piece of parchment on cutting board and put dough on top. Put the second piece of parchment on top of the dough and roll out with rolling pin (or wine bottle!) until dough covers the parchment sheet. Roll it out the same thickness or the thinner pieces will burn.
Remove top parchment and cut dough into pieces 2 inches square. A pizza cutter works beautifully for this if you have one.
Slide the parchment with the cut dough onto baking sheet and bake crackers 12-15
minutes, or until lightly browned.
Let crackers cool on the baking sheet for 30 minutes.

For biscuits: Butter your cookie sheet, or use a sheet of parchment paper. Drop small clumps of dough, about the size of a golf ball. Do not press or form them – let them stay fluffy and uneven.

Come up with alternate ways to use / modify this recipe? Let me know!

UPDATE 4/22/13: The meat pies were a hit! The insides were Vidalia onion, grass-fed beef, kale, fresh herb mix from Freddies, egg (3 for 2 pies), garlic, tumeric, salt, and pepper. I meant to add cubed carrots or parsnips, but I forgot.

"Adventurer Pie" with a grain free crust

“Adventurer Pie” with a grain free crust!

UPDATE 7/26/13: I have been using same recipe for a grain free crust for pizza. A double batch of the crust is the right amount to cover a cookie sheet. I use a second layer of parchment paper and a can of beans as a rolling pin to get it the same thickness all over. Top it with pesto sauce (no nightshades for me), salami, and cheese. Or try chicken, spinach, and mushrooms! Yum!!

Trusted Referrals & Healthy Shoe Shopping

Here’s a short list of professionals I recommend. Please let me know if you use one of these referrals – I’d love to hear how it goes for you!

Also – the second half is a guide to shopping for healthy shoes.

Physical Therapy:
New Heights
Locations in Vancouver, SE Portland, and NW Portland

Podiatrist: Dr. Ray McClanahan
Northwest Foot & Ankle
2701 NW Vaughn Street, Suite 424
Portland, OR 97209
(503) 243-2699

Personal Trainer:
Brandie Sylfae
(503) 422-0402

Rolfer:
Karin Edwards-Wagner
2732 SE 18th Ave Portland, OR 97202
(503) 230-0087

Massage:
Sally Leonard
Forget Me Knots
12655 SE Center St, Ste 530, Beaverton 97005
Yes, she’s in my office!
503-201-7110

Artisan Extraordinaire:
Custom clothing and enamel jewelry
L.A. Fine
acorncottageartisanry@gmail.com
(503) 285-4017

Clark Original on the left. The Jafe on the right is too stiff to be ideal for regular wear, but a rare find for fancy dress-up occasions.

Clark’s Original “Faraway Field” on the left, grey with mint stitching, also available in red, black, and brown. The Jafe on the right is too stiff to be ideal for regular wear, but works as a rare heel-less find for fancy dress-up occasions. Edited to add: The Jafe’s softened up with use, and the Clark’s model comes in more colors now! I just got myself some blue suede shoes!

Buying bio-mechanically correct shoes:
First, read this article about foot function and how to assess a shoe. Then, look for brands like Born, Clark’s, Keen, Lems, Jambu & J-41 (sexy sandals!), Vivo, Altra, Jafe, and Merrell. FiveFinger and Fila make minimal, separated toe shoes (personally, my short toes like the Filas much better – and they were a mere $30 at Big 5 sports!). Please note that I am NOT endorsing every model shoe the above brands make. For example, Keen has two footbeds, a stiff, narrow version (skip these!) and the one I like with the wide toebox.  In all brands, some models may be great, but others are too pointy-toed, too stiff, or have a heel. Shop carefully. When trying shoes on, you need to step on the insole itself and examine other factors discussed here. Try not to get carried away with something cute or a pair that feels “good enough” – your feet will get pickier as they adapt to having room to move! They will also spread out, so if you are between sizes, go up. Most people gain a half to a full size as their toes spread out. Winter boot guide here.

A happy surprise for the Pacific NW Fall weather - Bogs rainboots have no heel and give plenty of room for the front of the foot. I got my pair at Clogs & More on Hawthorne.

A happy surprise for the Pacific NW weather – Bogs rainboots have no heel and give plenty of room for the front of the foot. I got my pair at Clogs & More on Hawthorne.

Places to get biomechanically-correct footwear locally:

REI (surely you know where REI is)
FitRight NW  (they carry Lems) off NW 23rd
Pie in the Alberta district
Cobbler Bill’s near 82nd & Foster
Shoe Mill at the big malls
The Walking Company also in malls
Clogs N More – note – don’t buy clogs! :) Hawthorne and downtown
Imelda’s on Hawthorne
Footwise on Broadway

And don’t forget the toe socks so you can move freely inside your spiffy new shoes. Sock Dreams has a store in Sellwood, or you can order online. They carry unique, high quality stuff, including the elusive toesock with formed heels. They thoroughly describe their stock on the website, including measurement info like calf size. They ship superfast, for free, and, if you ask, they will do an ADORABLE drawing on your receipt.

Places to get biomechanically-correct footwear online:

soft-star-products

Part of the Soft Star shoe line. You can custom order your color choices!Ahimsa

Ahinsa Casual style, fabric shoes
Altra  Wide toebox running shoes
Belleville Military & law enforcement-type boots.
Lems ugly but comfortable
Oesh Variety of women’s styles from professional to casual.
Shoes for Crews Steeltoes, other serious work shoes & boots
Skidbusters Nursing, etc.
Soft Star Shoes Minimal, basically leather socks. Based in Corvallis
Tune Men’s penny loafers
Vibram FiveFingers and wrap shoes
Vivobarefoot Lightweight, minimal shoes and boots
Xero sandals, including DYI

 

Again, not everything these places sell will be good for your feet. Double check the shopping guide. I recommend wearing your new shoes inside for a while on a trial run (so they are returnable) before venturing out.