This middle aged gent presented to the clinic after visiting two other podiatrists and yet was still plagued with foot pain.
He is a fit and healthy man with no prior foot or ankle injuries. He has been training for the last 6 months for a local marathon. He developed right lateral foot pain approximately six weeks ago. There was no proceeding injury or ankle sprain. It became progressively sorer the more he continued to train. He sought treatment with a podiatrist who recommended custom orthotics. This made the pain worse. He tried them for several weeks and the pain persisted. The advice from the second therapist was to continue with the orthotics and stop running. He ceased running but the pain returned once he went back to running.
By this point this gent was quite exasperated about the pending race and he was still plagued by foot pain. My examination of his foot revealed very little. There was no pain on palpation of any bone or joint or soft tissue. There was no pain on passive or resisted movement of the foot and ankle. There was no swelling or bruising. Medical history was unremarkable. The patient pointed to the area of the dorsal cuboid area and described the pain as a deep aching pain. He had no pain in the foot during the day at the office.
Upon further questioning it was revealed that he had purchased new shoes two weeks before the pain started. He describes his old pair of shoes as being ‘cheap and old’ department store running shoes and decided to treat himself to better shoes. Looking that the shoes they were evidently a stability or anti-pronatory type shoe. A quick gait assessment showed that this gent has a fairly ‘neutral foot type’ with bilateral lateral ankle instability.
The immediate thought was he was experiencing lateral column overload from the anti-pronatory shoes. He did not bring in his orthotics for assessment but it is not difficult to surmise that these were likely contributing to the lateral foot overload. There was not a significant amount of over-correction present in the shoes but it was enough to be causing pathological loading changes in the foot.
I suggested he go and change his footwear back to a neutral runner with an even medial and lateral sole. I was pleased to have a phone call to say that all his pain had ceased and he was back to training full steam.
It is important to note that sometimes footwear can play a big role in contributing to injury and conversely reducing the risk of injury. If you suspect your shoes are contributing to your pain or need a footwear review we can assist and give advice on what sports shoes you should be looking for in future.