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Tales From The Frontlines Of Daily Shoe Battles

   Shoe battles occur daily in my practice. Many of my patients want to wear certain types of shoes they feel are necessary to have the “style” to promote themselves in their workplace, to look attractive and also to feel good about themselves.

   In many cases, these shoes that are an integral part of the fashion accessories that allow individuals to achieve a certain appearance are also the main cause of the foot pathologies that have brought these people to my office.

   For instance, consider the podiatrist who makes the error of assuming that even his or her most intelligent patients who wear stylish, ill-fitting shoes on a regular basis have any clue that these shoes could be the cause of their symptoms. For such podiatrists, it is instructive to provide an example of one of the shoe battles I frequently have with my patients.

   My new patient, Carol, a 50-year-old office manager, comes dressed in her business attire with 3-inch heels with stylish pumps that have very pointed toes. When Carol removes these very fashionable shoes from her feet, I immediately notice that her shoes appear one shoe size smaller than her feet and that her toes would need to be mashed together inside her shoes in order to fit into them.

   I first ask, “Carol, what brings you in today to see me?”

   With a concerned look on her face, she states, “My toes have red marks on the tops of them and all my toes are starting to curl. I also get a burning pain between my third and fourth toes that makes it difficult to walk.”

   We talk further and determine that there have been no injuries to her feet or other possible systemic causes of foot pain. I proceed to examine her and let her know that she is beginning to develop hammertoe deformities as well as a possible intermetatarsal neuroma.

   I ask, “How often do you wear shoes like these that you wore today?”

   Carol says, “Oh, I never wear these shoes, I just put them on today for an office meeting.”

   I respond with a question. “Could it be that the shoes you wear at work are the cause of your hammertoes and your developing nerve problem in your feet?”

    “I don’t think so. I always buy expensive shoes that are comfortable,” says Carol somewhat defensively.

   I ask further, “Have you noticed that your feet are more comfortable when you do not wear any shoes at all or when you wear athletic shoes?”

    “Why, of course, my feet do not hurt when I am barefoot or in the shoes I wear to the gym,” she replies.

   Now with a slight smile on my face, I continue, “Carol, you told me you have foot pain. Yet you also told me that your foot pain only occurs when you wear your dress shoes, which you say are comfortable. Most people would consider comfortable shoes to be shoes that don’t make their feet hurt.”

   We share a brief laugh. Then I describe mechanically what causes the red marks on her toes and what may have caused the hammertoes to develop over time from improper shoe fit. I also explain that the nerve pain she experiences may be due to the compression forces on the intermetatarsal nerve from the tight shoes she wears.

   At this point in the visit, I am very clear with the patient that if she would like to avoid possible surgery and would like to rid herself of foot pain, she will need to choose stylish shoes that better fit the shape of her feet.

   The dust is starting to clear from another great shoe battle in my office. On one side was the patient who had possibly invested thousands of dollars in clothes and matching shoes in her closet but was having foot pain as a result of her shoe choices.

   On the other side was the concerned podiatrist who was trying to find a way to convince the patient that if she could simply wear shoes that better fit the shape of her feet, she may be able to stand and walk all day without pain.

   In this battle, it is my firm belief that the winner will be the patient who has been fortunate enough to find the podiatrist who will honestly state the mechanical facts that the ill fitting stylish shoes are the main cause of the patient’s foot pain and also has the common sense to make the necessary shoe changes so the patient may again be free of foot pain.

Dr. Kirby is an Adjunct Associate Professor within the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University in Oakland, Calif. He is in private practice in Sacramento, Calif.

Dr. McCord recently retired from practice at the Centralia Medical Center in Centralia, Wash.

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Kevin A. Kirby, DPM
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