Table of Contents

• Inappropriate footwear is one of the most common causes of overuse injuries, particularly with beginners.

Common foot problems:

Bunions

A bunion is a painful enlargement at the joint off the big toe.

• The skin over the joint becomes swollen and is often tender
• Bunions can be inherited as a family trait
• Can develop with no recognizable cause
• Can be caused by shoes that fit poorly

An important treatment is wearing shoes that conform to the shape of the foot and do not cause pressure areas. This will often alleviate the pain. In severe cases bunions can be disabling. Several types of surgery are available that may relieve pain and improve the appearance of the foot. Surgery is usually done as a last resort to relieve pain.

Heel pain

Heel pain is extremely common.

• If often begins without injury and is felt under the heel
• usually while standing or walking
• Inflammation of the connective tissue on the sole of the foot (plantar fascia) where it attaches to the heel bone is the most common cause of pain
• It is often associated with a bony protrusion (heel spur) seen on X- ray studies.
• Most cases will improve spontaneously.
• Medication is used to reduce swelling of the soft tissues in the foot -Shoe inserts are also helpful

If pain continues, steroid injections or walking casts are sometimes used. Only in the most troubling and prolonged cases is surgery recommended.

Morton's Neuroma

Morton's neuroma is caused by a pinched nerve.

• This pinching usually results in pain between the third and fourth toes
• Tight shoes can squeeze foot bones together
• The nerve responds by forming a neuroma (a build up of extra tissue in the nerve )
• The neuroma results in pain that may radiate into the toes

Treatment usually involves wearing wider shoes or taking oral medications to decrease the swelling around the nerve. A pad on the sole of the foot to spread the bones is also helpful. A doctor may also inject cortisone around the nerve. If difficulty continues, surgery to remove the neuroma may be suggested.

Corns and Calluses

Corns and Calluses are caused by pressure on the skin of your foot.

• They may occur when bones of the foot press against the shoe
• When two foot bones press together

Common sites for corns and calluses are:

• On the big toe
• The fifth toe
• Calluses underneath the ends of the foot bones (metatarsals)
• Soft corns can occur between the toes

Treatment involves relieving the pressure on the skin, usually by modifying the shoe. Pads to relieve the bony pressure are helpful, but they must be positioned carefully. On occasion, surgery is necessary to remove a bony prominence that causes the corn or callus.

Hammertoes

Hammertoes are one of several types of toe deformities.

• Hammertoes have a permanent sideways bend in the middle toe joint.
• The resulting deformity can be aggravated by tight shoes
• Pain usually results over the prominent bony areas on the top of the toe and at the end of the toe.
• A hard corn may develop over this prominence.

Treatment usually involves a shoe to better accommodate the deformed toe. Shoe inserts or pads may also help. If there are still problems after trying these treatments, surgical treatment to straighten the toe or remove the prominent area of bone may be necessary.

Plantar warts

Plantar warts occur on the sole of the foot and look like calluses.

• They result from an infection by a specific virus
• They are like warts elsewhere, but they grow inward.
• The wart cannot grow outward because of weight placed on it when standing.
• Severe pain may be experienced when walking

Plantar warts are extremely difficult to treat, but success has been achieved with repeated applications of salicylic acid (available over the counter) to soften the overlying callus and expose the virus. Other treatments include injection of the warts with medication, freezing the warts with liquid nitrogen and very rarely, surgery.

Purpose of an Athletic/ Fitness Shoe

• Protect the foot from impact and abrasion
• Support the foot
• Improve traction

Shoe Anatomy

Outsole

• The outsole is the outer layer of material that provides traction
• The component materials of the sole and the tread design determine the overall traction and durability of the outsole.
• The two most commonly used compounds are carbon rubber (the black soling on running shoes) and styrene-butadiene rubber, found on most court, basketball, and tennis shoes.

Midsole

• The midsole, the heart of the cushioning system, contains a layer of shock-absorbing foam placed directly over the outsole and underneath the insole of the athletic shoe.
• The type and quality of midsole material used in athletic shoe construction significantly affects overall performance and durability of the shoe.
• The two most common midsole materials appropriate for fitness activities are:
  • ethyl vinyl acetate (EVA). This chemically blended foam material is used in lightweight midsoles and heel wedges. EVA is probably the most popular material for quality running shoes and aerobic dance shoes because of its lightness, flexibility and impact resistance. The quality of EVA varies considerably among shoe models. In general, compression-molded EVA is more durable and shock-absorbent than traditional open-cell EVA.
    
  • polyurethane (PU). Polyurethane is a liquid polyester that forms an extremely durable closed-cell foam material used in midsoles and outsoles. The advantage of PU over EVA is its durability and superior shock-absorbency. However, because polyurethane is generally slightly stiffer and significantly heavier than EVA, it is used less in athletic footwear.

The upper

• The material sewn into the midsole or outsole comprises the upper.
• The largest pieces of the upper are called the quarters (sides of the upper) and the vamp (top surface of the shoe upper).
• The most popular upper materials include leather, woven soft nylon (taffeta), and coarser-grade nylon knitted into a mesh configuration for strength and breath-ability.

Heel counter

• The heel counter is a rigid or semirigid, moldable, external strengthening device in the heel area of the upper.
• Its purpose is to control and stabilize the wearer's heel inside the shoe and minimize excessive supination or pronation of the foot.
• The heel counter is a vital support feature
• In general, more expensive athletic shoes have reinforced heel counters with extra "stabilizer bars" made of plastic or polyurethane wrapped outside the heel counter and firmly attached to the midsole of the shoe.

Foxing and toe box

• Foxing is extra material (usually suede or rubber)
• It gives medial and lateral support to the outside of the shoe
• In running shoes, the important foxing is at the toe of the upper, forming the toe box.
• In court shoes, the foxing usually includes rubber wrapped around the sole for lateral support.
• In the popular cross-trainer shoe, foxing can be quite rigid, with stabilizer bars or struts composed of rubber or polyurethane in the forefoot area.

• You should buy new shoes about every three to six months or 300 to 500 exercising miles. Since the midsole usually wears out first, you should not use the outer sole as an indicator of use.

Learn your foot shape

• Lay a brown grocery bag flat on a hard surface
• Get your bare feet wet then walk across the paper
  • Straight feet leave an oval shaped imprint
  • Semi-curved feet show the forefoot and the heel connected by a band about two to three inches wide
  • Curved feet have a narrow band connecting the heel and forefoot
• During activity your foot may pronate (roll inward to absorb impact of the heel or foot striking the ground ) or supinate (roll outward to stabilize the foot between steps or strides )
• Underpronation may require extra cushioning in the medial midsole region
• Oversupination may require extra support in the heel counter
• Some athletic shoes have gel inserts or airbags in the midsole, ball and/or heel of the shoe to support the foot and absorb the shock as each part of the foot hits the ground
• Make sure you have ample room in the toe box
• Allow for about a half-inch between the end of your toe and the shoe
• When the laces are tied snugly, your feet should not shift in the shoe when walking
• The shoe should be flexible, particularly in the toe and midsole
• It should bend easily when its toe is pushed against the ground
• The shoe should also cradle the heel comfortably with a firm heel counter
• If the shoe fits uncomfortably when you first try it on, do not buy it -- it will most likely be uncomfortable during exercise.

Things to watch for...

• Shoes with firm midsoles (the part directly under your foot that cushions impact) reduces lateral (side to side) stress on the knees
• Soft-midsoles may feel better but they do not protect the knees from strain causing torque
• Soft midsoles accentuate pronation, while hard midsoles act as a supportive orthotic
• Too narrow shoes can squeeze the ball of the foot, this can deform toes and can lead to Morton's neuroma
• Too wide shoes can cause blisters and raise the risk for strains and sprains as your feet slip and slide inside the shoe
• Too short shoes bruise and blacken toenails.

What to look for when purchasing an athletic shoe...

• As a rule of thumb if the shoes cost at least $60.00 (they will have technology to protect you)
• Check inside the shoe for a removable (foot conforming) insole-- an insole helps cut the risk of pounding injuries to heels and legs
• Check the heel for a stiff heel-- that is what keeps your foot from twisting too much with every stride, which can cause leg muscles and tendons to ache or tear
• Inquire about midsole composition for durability and performance, select shoes with either compression-molded ethyl vinyl acetate (EVA) or polyurethane (PU).
• Examine the inside of the shoe as well as the insole (shoes with removable insoles are preferable because they tend to be better cushioned and allow the fit of a custom foot orthotic)
• Pick shoes from at least five different makers, and try them on, look for comfort (it should feel comfortable from the moment its on your foot ) You should NOT have to break in athletic shoes!
• Walk around in the shoes, jog in place, jump around (try to do these things on the tile and not just carpeting).
• Ask yourself:
  • Are the arches and heels snug without rubbing or slipping?
  • Does the shoe bend where your foot does, at the toe joint?
• Generally, a single pair of shoes worn at least four days per week for any fitness related activity should be replaced every four months. if the shoes are polyurethane midsole, the wear may be extended up to six months. if they have a standard, open-cell, EVA midsole they may last only three months.

Personalizing Your Shoe Selection

Body/ Foot Type

If you:	Pick a shoe that:
are heavier or taller	has a firm, dense midsole, like polyurethane (PU)
are lighter or smaller	has a softer midsole, like compression-molded ethyl vinyl acetate (EVA)
have a high arch	is well cushioned and soft
have a flexible arch or flat foot	is firm and has motion-control features.

Injury History

if you have had:	Pick a shoe that:
stress fractures	is cushioned in the midsole and insole.
plantar fasciitis	is flexible, and has a well-contoured insole with a prominent arch support.
ankle sprains	has a firm PU midsole with a 3/4- high reinforced upper.
shin splints	has an elevated heel, plenty of cushion, and a contoured arch insole
knee problems	has a firm sole with a lateral reinforcement in the upper

Activities

if you regularly participate in:	You need:
aerobics/ dance exercise only	an aerobic-dance shoe or a cross trainer. If you have had arch or heel problems, choose an aerobics shoe because it is more flexible
weight training, stair climbing, and stationary biking	a cross trainer
aerobics/ dance exercise, weight training, stair climbing and biking	a cross trainer or aerobics shoe with a PU midsole
aerobic/ dance exercise and running	an aerobics shoe and a running shoe
aerobics/ dance exercise and fitness walking	an aerobics shoe and either a walking shoe or a running shoe

Buyer's guide

• Choose an athletic-shoe store or specialty store that has trained personnel with a reputation for providing quality fitting.
  • Should have a large inventory to make a variety of sizes available
    
• Try to get fitted for footwear at the end of the day, when foot size is at its maximum
  • It is not unusual for an individual to increase up to half a shoe size during the course of a single day of standing or walking because of swelling and soft tissue expansion.
    
• The socks worn when trying on new shoes must be the same worn during the activity.
  • Socks and shoes must fit together, particularly with the popularity of padded athletic hosiery.
    
• Since most people do not have identically matched feet in terms of shoe size, have both feet measured in width (girth) and length.
  
• If the shoe does not feel right in the store, do not buy it
  • If it fits, it fits the first time, athletic shoes should not be expected to stretch or accommodate to abnormal foot shapes.
    
• Plan to take at least a half hour to fit your shoes. Try wearing them around the store
  • you should have an opportunity to simulate athletic movements of a particular activity to determine if the shoe will perform properly.
    
• Try to compare one brand of shoe to another by placing one model on the right foot and a different model on the left foot
  • This allows an instantaneous comparison of flexibility and cushioning characteristics as you simulate running or hopping movements in the store
    
• Test the flexibility of the shoes by rolling up on the toes
  • If the heel slips out of the back of the shoe, the shoe itself is to stiff in the forefoot.
    
• Test forefoot cushioning by jumping up and down on the toes, test rearfoot cushioning by running on the heels.
  
• Test lateral stability by standing up on one foot and twisting the foot side to side while balancing on the foot
  • If the foot slips laterally in the shoe, the upper is unable to control the foot adequately.
    
• If the shoe has variable-width lacing, experiment with the narrow and wide eyelets to achieve a better custom fit
  
• Whether a shoe feels superior in terms of flexibility or cushioning, the fit characteristics supersede all others in terms of ultimate selection of the proper shoe.
  • If the shoe does not fit properly, it will never perform properly and will cause discomfort and potential injury

Athletic shoes are grouped into seven categories:

1. Running, training, and walking.

Includes shoes for hiking, jogging and exercise walking.

• Look for a good walking shoe to have a comfortable soft upper, good shock absorption, smooth tread and a rocker sole design that encourages the natural roll of the foot during the walking motion
• The features of a good jogging shoe include: cushioning, flexibility control, stability in the heel counter area, lightness, and good traction.

2. Court sports.

Includes shoes for tennis, basketball, and volleyball.

• Most court sports require the body to move forward, backward, and side-to-side.
• Most athletic shoes used for court sports are subjected to heavy abuse.
• The key to finding a good court shoe is its sole.
• Ask a coach or shoe salesman to help you select the best type of sole for the sport you plan on participating in.

3. Field sports.

Includes shoes for golf, soccer, football, and baseball.

• These shoes are cleated, studded, or spiked.
• The spike and stud formations vary from sport to sport, but generally are replaceable or detachable cleats, spikes or studs affected into nylon soles.

4. Winter sports.

Includes footwear for figure skating, ice hockey,. alpine skiing and cross-country skiing.

• The key to a good winter sports shoe is its ability to provide ample ankle support.

5. Track and field sport shoes.

Because of the specific needs of individual runners, athletic shoe companies produce many models for various foot types, gait patterns, and training styles.

• It is always best to ask your coach about the type of shoe that should be selected for the event you are participating in.

6. Specialty sports.

Includes shoes for golf, aerobic dancing, and bicycling.

7. Outdoor sports.

Includes shoes used for recreational activities such as hunting, fishing, and boating.

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