The Anatomy of… a Shoe!

Within every profession, there are descriptive terms to specify characteristics or locations of features on an item. For a botanist, the anatomy of a plant is crucial in determining how a plant functions and plays an important role in how it reacts to its environment. For the musician, each instrument has their own sound and frequency as dictated by its anatomy – all the parts work together! For many healthcare professionals and patients, it makes sense that the human body has its own anatomy – there’s a name for every bone, joint, ligament, tendon, organ and blood vessel. And even those structures have structures on or within them that are named or classified. Each area of study has its own focus and that focus is very detailed.

In regards to biomechanics of the foot, a podiatrist must be knowledgeable of all the structures and the geography within the foot. In addition, the anatomy of footwear is also important to know. It helps the clinician evaluate the footwear and deem it worthy or unworthy of your feet. Below is a list of the structures in a typical tennis shoe. Shoe designers and shoe manufacturers must also have an expert handling of shoe terms because they work with its creation on a day-to-day basis.

For a shoe to work, all the components must be secure, comfortable and work together in harmony. Different shoes have different functions or combinations of functions: arch support, shock absorption, balance, traction and ambulation. In addition, athletic shoes designed specifically for a sport all have properties that help the activist excel in that sport.

Below is a basic diagram of a typical athletic shoe with various parts labeled. Descriptors of the terms will follow in the next article. With a little time, you too can be familiar with all the components of a tennis shoe and their functions! Who knew that even tennis shoes had such a specific anatomy!?
All the different components of an athletic shoes work together to keep the foot protected, balanced, and optimize its performance. Athletic shoes of various sports have variations of the characteristics listed above to enhance performance of the foot.

Refer back to the diagram in the previous article to help you learn the terms and their functions in regards to their placement on the shoe!

Upper – the entire portion of the shoe that covers the foot

Sole – the entire portion of the shoe that the foot rests upon

Shoe upper + shoe sole = entire shoe

Toe box – the horizontal and vertical space near the tip of the shoe to accommodate the toes, comes in different shapes

Vamp – the upper, middle section of the shoe were the laces are located – Velcro fasteners may also be found in the vamp section

Laces – one of the common closure types of shoes (Velcro is another one) – the purpose of laces is to anchor the shoe firmly onto the middle portion of your foot

Eyelets – a round cutout in the vamp section of the shoe to allow the passage of laces, the resistant material that encircles the eyelet is called the eyestay

Tongue – a thick flap of material that sits underneath the laces to protect the top of the foot from pressure of the laces

Top line – the top edge of the upper portion of the shoe

Achilles notch – always found at the back of the shoe, this notch keeps the Achilles tendon from encounter irritation from the shoe

Heel counter – stiff material employed to reinforce the shape of the back portion of the shoe, helps with shoe fit and shoe stability

Outsole – the outsole is the portion of the shoe that directly contacts the ground

Quarter – the portion of the shoe that covers the heel and connects it to the vamp

Athletic shoes in different sports have modifications of the characteristics listed above to help enhance the wearer’s performance and to protect the wearer’s feet. For example, basketball shoes have a much higher topline (hi-top shoes) to help keep the ankle in place and reduce the incidence of ankle sprains. Soccer and football cleats have large studs on the bottom of the sole (connected to the outsole) to provide traction on the playing surface. So next time you’re in a shoe store with a friend, impress them with your knowledge on shoes!

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

Achilles Tendonitis

The Achilles tendon is a continuation of the calf muscles.  More specifically, it is a continuation of the soleus and gastrocnemius muscles.  The tendon serves as an attachment of the muscles to the heel bone, known as the calcaneus.  The Achilles tendon plays a vital role in walking, by helping to lift the heel off of the ground. 

            Common conditions affecting the Achilles tendon include Achilles tendonitis and tendonosis.  Symptoms of both of these conditions include pain and tenderness in the area directly above the heel.  This pain may be worse in the morning after a long period of rest, or with a prolonged period of activity.  The pain can usually be reproduced by squeezing the tendon. 

            Both Achilles tendonitis and tendonosis are considered to be overuse injuries.  They are commonly seen in patients who have just begun rigorous exercise programs, laborers, and “weekend warriors” – those who participate in physical activity on the weekends and may be less conditioned than more regular athletes.  During these activities, too much stress is put on the tendon too quickly, which can lead to micro-tears and ultimately pain.  Tendonosis refers to these tiny micro-tears, while tendonitis refers to the actual inflammation.  Because the activity is ongoing, the injury to the fibers of the tendon can alter the shape of the tendon, leading to a situation of prolonged pain. 

            Once diagnosed by a doctor, Achilles tendonitis and tendonosis will usually be treated first with immobilization.  This is generally achieved by putting the affected foot in a cast or a removable walking boot.  Icing the inflamed area will help bring down some of the inflammation and relieve some of the pain – anti-inflammatory drugs like ibuprofen may help with this as well.  Once the pain from the tendon subsides, physical therapy may be used to strengthen the muscles, which can help prevent future cases of Achilles tendonitis and tendonosis.  Physical therapy can also be used to help improve running form.  Proper footwear is another important step in preventing the conditions, as well as preventing other conditions that can develop from physical activity. 

            If you are experiencing pain that you think may be Achilles tendonitis/tendonosis, it is important to have your ankle evaluated by a foot and ankle specialist.  Only they will be able to rule out other possible causes, and treat the condition effectively.  Remember that pain is never normal, and should be taken care of promptly and appropriately.  

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

Got Sesamoiditis?

Got a pain in the ball of your foot?  One possible explanation is sesamoiditis.  Sesamoiditis is a pain in the ball of the foot underneath the big toe.  This is where the sesamoid bones are located. 

Sesamoid bones are bones that are embedded in tendons, and help reduce friction and act as a pulley across a joint.  This makes the motion of the joint much smoother, and more efficient.  The sesamoids of the great toe help to increase leverage during the toe-off phase of gait.  These bones are about the size of a kernel of corn. 

Sesamoiditis is most common in young, active people.  It is particularly common in runners and dancers, as there is a lot of pressure put on the ball of the foot during these activities.  Every time that you push off with your big toe, the sesamoid bones are involved in the movement.  This can eventually lead to irritation.  Since the sesamoid bones are buried within a tendon, sesamoiditis can actually be considered a form of tendonitis, as the tendon encapsulating the bones are generally inflamed as well.

Cases of sesamoiditis are usually distinguished from other causes of foot pain by their gradual onset.  The pain will typically begin as a mild ache during activity, that slowly progress to a more intense, but dull, pain.  Most cases do not show any apparent signs of redness or bruising of the skin.  Sesamoiditis generally is caused by an increase in physical activity.  This may be seen in people just beginning to run or dance, or in a runner that has recently increased mileage or intensity of their training.  It is also often seen in baseball catchers, who usually put a lot of weight on the balls of their feet.

Sesamoids, like any other bone in your body, can also fracture.  When your doctor diagnoses sesamoiditis, they will take an X-ray to see if the bones are fractured or not. 

Treatment of sesamoiditis starts with a good amount of rest.  It is important to stop the activity that is causing the inflammation.  Invasive measurements are usually not necessary.  Icing the effected area will help lessen the pain, as well as non-steroidal anti-inflammatory drugs (NSAIDS).  Sesamoiditis can be prevented by wearing a well-padded shoe when performing physical activity.  Some people may simply not have a thick enough fat pad in the ball of their foot.  This may be aided by a soft metatarsal pad inserted into the shoe.  

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

Annual Best Walking Cities Competition

The American Podiatric Medical Association, in partnership with Prevention magazine, has just published the results of the annual Best Walking Cities Competition.  Topping the list this year was San Francisco. 

            The Best Walking Cities Competition takes an analytical look at the 100 largest metropolitan areas of the United States, and ranks them according to various categories, such as the amount of trails and public parks in a certain area, and the percentage of people that walk for fitness. 

            In addition to the objective analysis, a panel of nationally-recognized experts on the subject was asked to weigh in on the competition.  These experts were asked to weight the criteria, as well as to rank the cities on walkability. 

The top ten cities are:
1.      San Francisco, CA
2.      Boston, MA
3.      New York, NY
4.      Philadelphia, PA
5.      Chicago, IL
6.      Washington, DC
7.      Seattle, WA
8.      Honolul, HI
9.      Portland, OR
10.  Pittsburgh, PA

Walking is a very healthy activity, and one of the most popular forms of exercise out there.  It is easy to do, and has been shown to decrease the risk of heart disease, stroke, obesity, diabetes, and cancer.

To read more about the Best Walking Cities Competition, check out this link to the APMA website.  You can find out more about the results, including where your city falls on the list!

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

What is a gout?

 

A swollen, red joint in the big toe is considered a hallmark sign of gout?

True or False

Dr.’s RESPONSE:  This is absolutely true.  In fact, it even has its own name: podagra.  Gout is a recurrent acute arthritis that affects peripheral joints, most notably the big toe joint.  The condition is due to a build up of monosodium urate crystals in and around joints and tendons. Highly saturated body fluids condense and then crystallize.  These crystals cause severe pain in the affected joints.  It’s almost as if there a tiny needles in the joints.  With each movement, those small needles scrape against the tissues, causing severe pain.  Acute gouty pain is unmistakable.  Patients often describe it as though they cannot even bear to have bed sheets touch their foot.  Another common complaint is that the air conditioner blowing on the affected foot is extremely painful.  Other symptoms include sudden onset of single joint pain, low grade fever, 20:1 male to female ratio, crunchy tophi formation, and a red hot swollen big toe joint. 

Acute gout may become chronic and deforming.  Chronic gout causes destruction of the joint edges and actually erodes away portions of bone.  It can also lead to the accumulation of gouty tophi, a substance created by the body that resembles shards of glass mixed with cottage cheese.  These accumulations can develop in the feet, hands, on the elbows, knees, ears, and even the tip of the nose.  

Gout classically begins in the morning or early evening and tends to occur in previously damaged joints.  The well accepted theory is that gout crystals have an aversion to warm parts of the body.  But they also need a large enough area to accumulate.  Therefore, the big toe joint, far away from the main heat source of the body and yet large enough to allow urate crystal deposition to occur is the ideal location for these crystals to condense.  Many factors contribute to the formation of these crystals, with diet being a major contributor. Avoid organ meat, lard, sardines, alcohol (especially red wine), diuretics, and certain medications. 

There are basically two kinds of gout which are the “under-excretors” and the “over-producers.”  Under-excretors are those individuals that can not clear enough of the crystals from the blood stream via their kidneys.  This is the more common type of gout and it is also known as renal gout.  The other, less common type is known as metabolic gout.  This is due to a defect in genetic enzymes.  Both are treated with medications and lifestyle changes.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.flfootandankle.com

 

Barefoot Running

The barefoot lifestyle and barefoot running is a trend gaining popularity in the running community.  Opinions on barefoot running vary greatly, from “Absolutely Not” to “Absolutely No Other Way”. 

            The barefoot community claims that running barefoot improves the runner’s form, and eliminates problems like knee and hip pain.  This is due to a change in form.  When wearing running shoes, which typically have a thick padded cushion in the heel, striking the ground with the heel first sends shock all the way up the leg.  This force is largely absorbed by the knee, as well as the hip and back, which can be transferred to chronic pain.  Barefoot running eliminates the option of heel striking, forcing the barefooter to land on the balls of the feet, with the feet lined up directly underneath the hips.  This allows the force to be displaced more evenly, avoiding common running injuries.

            Many claim that the barefoot lifestyle is the only way to go.  Advocates of a barefoot lifestyle claim that it is the only true way to feel the ground, and that keeping your foot in a shoe all day is bad for the mind and the spirit.  Barefoot running expands into barefoot walking, even barefoot driving!

            But is the barefoot lifestyle a wise decision?  The opinion on the other side of the spectrum is that barefoot running and walking can lead to serious health problems.  Imagine walking around barefoot all day with an “improper” form, striking with your heel.  This would lead to some serious heel pain.  Also, a barefoot lifestyle offers no protection against the elements, and no protection against debris that may be on the ground.  Puncture wounds on the foot can lead to serious infections. 

            Still, even with the obvious thought that a barefoot runner’s feet would get chewed up by the elements and terrain, barefoot running has a significant following.  In fact, many bare footers prefer a rough terrain like asphalt to a soft terrain like grass or sand!  There has been much reporting on the barefoot lifestyle, including this article found in New York Magazine, which discusses the idea of shoes wrecking our feet by wearing shoes.  There are websites devoted to a barefoot lifestyle, like the Society for Barefoot Living and RunningBarefoot.org.

            While many may shudder at the thought of walking to the store with no shoes on, or running on a city sidewalk barefoot, there are those who would have it no other way.  Which side of the fence are you on? 

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.flfootandankle.com

Are Running Shoes Good for Walking?

As a general rule, running shoes are good for walking, but walking shoes are not good running shoes. Podiatrist Bob Baravarian, Chief of Foot and Ankle Surgery at Santa Monica-UCLA Medical Center and OrthopedicHospital, says that walkers should look for a pair of comfortable, easy fitting shoes that combine stability, cushioning, and some flexibility to correct stride problems. The right shoes can prevent or alleviate the three most common overuse injuries walkers suffer: plantar fasciitis (pain in the heel), Achilles tendonitis (pain from the back of the heel up the calf), and posterior tibial tendonitis (sore arch or inner ankle).

DR.'S RESPONSE:  Remember that when you go shopping for shoes to do it later in the day. This is because as we walk during the day and because of dependency, our feet tend to swell as the day progresses.  Therefore, you should buy your shoes when your feet are their biggest. Also, there is a great disparity in sock thickness.  So when you go shopping, you should wear socks that you would normally wear with those types of shoes. check out our online store for shoes

Central Florida Foot & Ankle Center,LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.flfootandankle.com

Cracked Heels

CRACKED HEELS ARE NOT ONLY A FASHION FAUX PAS, they can be very painful...

 

THE CAUSE: The most common cause is open backed shoes. They offer limited stability and toes are forced to claw to keep the shoe on. This contributes to the foot rolling in which can create callus formation and cracking. There’s also the theory that continual slapping of the shoe against the heel can contributes to cracking.

THE CURE: Wear shoes with a strap around the heel or ankle to offer stability and decrease callus formation. Use a foot file weekly and a foot cream which contains a salicylic acid. If this fails you should see a podiatrist for a professional treatment.

DR.'S RESPONSE:  Cracked heels are painful because they are really a result of overly dry feet. These sores are like having small cuts on the back of your heel.  Because our heels are constantly in contact with shoes when we walk, this repetitive motion exacerbates the condition.  The best treatment is to use a product call Carmol 40 or Kerasal.  Both products are made of urea, an emollient that helps soften and moisturize your skin.  Apply to affected areas three times a day, followed by the application of socks to lock in the moisture.  You should notice a difference after 1 week of treatment.  Try to apply after taking a shower or bath as well.  After 1 week of treatment, apply to affected area twice daily and then down to once daily for maintenance.  

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.flfootandankle.com