Metatarsal Pads

Metatarsal pads are used to help spread your transverse arch (the arch behind the ball of your foot, that runs across the width of your foot), promote the return of your overextended toes to their normal anatomical position, and encourage the return of your forefoot fat pad to its rightful position supporting your metatarsal heads. Your metatarsals are the long, thin bones in your mid-foot. The heads of your metatarsals are at the ball of your foot, and they connect to the base of your toes. Metatarsal pads help properly realign your metatarsal heads and the fat pad that’s underneath them. This, in turn, can help straighten and realign your toes, especially when your metatarsal pads are used in conjunction with our toe-spacing product (Correct Toes).

The conventional footwear features of heel elevation, toe spring, and toe taper can
negatively affect your foot over time. After many years of weight-bearing activity in shoes possessing these design characteristics, your feet become shaped like the shoes you wear. Your toes become chronically overextended (pointed upward) and tapered toward your foot’s midline. The muscles under your foot, your flexors, become excessively stretched and weakened, while your extensors, on top of your foot, become too tight. In turn, your forefoot’s fat pad, which normally provides cushioning for your metatarsal heads and the nerves between them, becomes displaced too far forward. The bones and nerves in this area are then relatively unpadded and therefore vulnerable. This foot configuration can lead to a host of problems, including, but not limited to, Morton’s neuroma, sesamoiditis, and plantar fasciosis, or more simply: pain in the ball of your foot, heel, or both.

Metatarsal pads, when properly placed within a completely flat shoe with a sufficiently wide toe box, can help undo muscle imbalance in your foot. Metatarsal pads help reconfigure your foot to the position that nature intended; that is, with splayed metatarsal heads, splayed toes, and a fat pad located directly underneath the fragile bones and nerves in the ball of your foot. Numerous foot and lower extremity problems can be prevented or reversed by restoring your natural foot anatomy and function.

It’s important to place your metatarsal pads correctly in your shoes. Please see our document on the proper placement of metatarsal pads. Improper placement of pads is uncomfortable and could possibly worsen your foot condition. Also, as with Correct Toes, it’s important to use metatarsal pads in shoes that are completely flat (i.e have no heel elevation, no toe spring, and no padding under your arch) and widest at the ends of your toes (not just at the ball). Finding such shoes can be challenging. Please see our list of healthy footwear options.

Bottom of pad contains a sticky adhesive for easy placing. Click here for more detailed information on placing metatarsal pads.

To purchase metatarsal pads click here.

–Dr. Ray McClanahan, DPM, Northwest Foot and Ankle / Correct Toes

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Are Clogs a Foot-Healthy Choice?

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Introduction

From restaurants to offices to hospitals to healthcare clinics, clogs are ubiquitous footwear in work and casual environments alike. A traditional clog is made solely from wood, while contemporary clogs incorporate wood soles (or no wood at all) with upper materials such as leather, which allows for more versatility and greater comfort. Today’s clogs (such as Danskos) are inspired by that original wood-style design, and they are sometimes backless, almost always have a heel and pitched toe box, and are usually stiff.

Clogs are a traditional part of many cultures throughout the world, including Dutch, Swedish, and Japanese cultures, and are worn for several key reasons, including protection, fashion, and for certain types of dance. The popularity of clogs has increased in recent years, as many consumers have been persuaded that clogs are a practical and foot-healthy option.

But is this belief fact or fiction? And are clogs really any different from “conventional” footwear? Let’s find out.

Myths Abound

Many doctors (including podiatrists) recommend clogs to patients who have foot ailments. In fact, the American Podiatric Medical Association (APMA) has given its Seal of Acceptance to Dansko (a leading brand of clogs) after rigorously evaluating their products and determining them to promote “quality foot health.” Some of the features that earned Dansko this “high praise” include anatomically contoured arch support, rocker-bottom soles, and heel elevation—a feature that some doctors believe eases strain on leg and back muscles.

It’s no wonder, then, that clogs have gained an almost mythic reputation for being foot-healthy footwear. Sadly, this reputation is built on an incredible amount of misinformation, aided and abetted by the APMA and other groups who, unbelievably, tout arch support, bizarre sole construction, and heel elevation as beneficial shoe design features. The idea of clogs as beneficial footwear has gone mainstream, but the underpinnings of this belief are nothing more than regurgitated shoe industry myths about what constitutes a healthy and stable home for your feet.

The Truth About Clogs

Some people who wear clogs do experience a degree of foot pain relief. Unfortunately though, the relief is often temporary, mainly because clogs fail to address the true underlying cause of most foot and toe problems. So while the diminished pain makes it seem like the problem has been resolved, wearing clogs on a regular basis actually sets people up for further (and often worse) foot ailments down the road.

The truth is, clogs are among the most harmful or injurious shoe types available to consumers. Most clogs share many of the same unfavorable design features that other conventional shoes possess (please see the section immediately below). Clogs, like other conventional shoes, strip your foot of its inherent power, destabilize your main foot arch, and contribute to common toe deformities and problems, such as hallux valgus, bunions, tailor’s bunions, hammertoes, clawtoes, among others. Clogs also make it difficult for you to experience much (if any) tactile feedback from the ground you walk on, due to their extraordinary thick and rigid soles.

You won’t hear this truth about clogs from many other sources, which is why it’s so important to heed this warning: Clogs, like other types of conventional footwear, cause or contribute to many foot and toe problems, including neuromas, plantar fascia pain, and ingrown toenails. And they do this because they place your feet and toes in unnatural, compromised positions for many hours at a time. It’s only by examining the harmful design features included in most clogs, though, that you’ll get a better sense of how clogs impair foot health and cause problems.

Harmful Shoe Design Features

The following design features are common inclusions in most clogs. These features, either individually or collectively, alter foot anatomy or function in an unfavorable way and should be avoided:

  1. Rigid Soles. Thick, rigid soles make it almost impossible to get a sense of the ground you’re walking on, which may predispose you to errant footfalls and ankle injuries. The biggest problem with rigid soles, however, is that they hold your feet and toes in a compromised and deformed position for prolonged periods. When you wear shoes with rigid soles, it’s like putting your foot in a cast and expecting it to get stronger. In most cases, only a very thin layer of material between your foot and the ground is all that’s required to adequately protect your sole.
  2. Heel Elevation. Most clogs possess a design feature called heel elevation that raises your heel above your forefoot. Heel elevation is problematic for several reasons. First, it destabilizes your inherently strong principle foot arch (your medial longitudinal arch). Second, it places excessive pressure on the ball of your foot and the many important structures located in this part of your foot (bones, nerves, etc.). And third, it increases your likelihood of an ankle sprain, as an elevated heel is less stable and rolls more freely from side to side than a heel that is flat on the ground. A foot-healthy shoe has a completely flat sole, from your heel to your toes.
  3. Tapering Toe Boxes. Toe box taper—and the wedge-like position it forces your toes into—is a major problem associated with most conventional shoes, including clogs. There is a common belief that clogs possess a “wide toe box,” and that this is good for foot health. While it’s true that a wide toe box is a foot-healthy design feature to look for in footwear, most shoes that claim to have a wide toe box—including many varieties of clogs—are actually widest at the ball of the foot, not at the ends of the toes, where you need it the most. A true foot-healthy shoe possesses a toe box that allows your toes to splay properly, the way nature intended.
  4. Toe Spring. Toe spring is another major design flaw built into most conventional footwear, including clogs. Toe spring, also known as toe ramping, is a design feature that elevates your toes above your forefoot. When combined with heel elevation, toe spring effectively acts to invert your main foot arch, destabilizing your arch and putting excessive pressure on the ball of your foot. When it comes to toe spring, what’s especially pronounced is most clogs (even more than other types of footwear) is both the toe spring itself and the rigidity of this toe spring. The rigid toe spring built into most clogs holds or immobilizes your toes in an unnatural, extended position, which contributes to foot tendon imbalances and tight toe extensor muscles over time. Tight toe extensor muscles and tendons can cause various toe deformities, collectively known as crooked toes.

Lasting Effects of Clogs (& Other Injurious Footwear)

Clogs unnaturally alter your weight distribution and immobilize your foot joints—two circumstances that can (in some cases) contribute to temporary pain relief. But wearing clogs “kicks the can down the road” and leads to chronic foot problems later on. Many of the foot problems that eventually befall clogs-wearers develop painlessly and are masked (at least initially) by the reduced foot sensitivity that comes from wearing such an extremely rigid-soled shoe.

Clogs and other conventional footwear can cause both immediate and long-term discomfort and foot problems. Some research indicates that the loads on hip and knee joints are significantly higher in people who wear conventional footwear than in those who walk barefoot. A 2006 study published in the journal Arthritis and Rheumatism states that conventional footwear may be contributing to the prevalence and progression of hip and knee osteoarthritis in our society. Osteoarthritis is an extremely painful joint problem that’s associated with excessive joint wear and tear. This health problem can significantly affect your quality of life and keep you from enjoying your favorite physical activities.

Conclusion

Clogs are not what they are touted to be. And wearing clogs is not a way for you to improve or preserve your foot health, as most clogs include design features that cause foot pain and problems, either now or down the road. To truly preserve foot and toe health, seek out footwear that is flat from heel to toe, possesses a toe box that’s widest at the ends of your toes, and has a sole that can be easily flexed and twisted. It’s also important to restore normal, healthy foot and toe anatomy after years of wearing conventional footwear. A toe-spacing device, such as Correct Toes, can help you do just that.

Check out our Shoe List for examples of shoes that truly support natural foot health. You can also download our Shoe Selection Guide.

References

  • American Podiatric Medical Association. Dansko, LLC. http://www.apma.org/Learn/company.cfm?ItemNumber=1432. [accessed 2013 Jun 20].
  • Shakoor N, Block JA. Walking barefoot decreases loading on the lower extremity joints in knee osteoarthritis. Arthritis & Rheumatism. 2006. Sep; 54(9): 2923-2927.

Authors of this Article: Robyn Hughes, ND & Ray McClanahan, DPM

Meet “The Emperor’s New Shoes”

ImageThe Emperor’s New Shoes is a UK-based natural running store that sells shoes and accessories (including Correct Toes) and offers advice and coaching to enable people to run as nature intended.

We recently had the chance to interview the owners of The Emperor’s New Shoes, Sam Murphy and Jeff Pyrah. Here’s our conversation:

Please tell us a bit about yourselves and The Emperor’s New Shoes.
We have both been avid runners for decades – we fell in love with barefoot running and minimalist shoes a few years back, but quickly realised that they were very hard to come by outside of London. People had heard of them, but not seen them or tried them. So we set up the Emperor’s New Shoes as an online and mobile store. We go to races and events to talk to runners about the benefits of natural footwear, and give them an opportunity to actually feel these shoes on their feet. All the shoes we sell fulfill certain criteria – a wide toe box, lightweight, flexible, and low or no heel-toe drop. We only sell shoes that we have personally wear-tested and liked, along with a select range of accessories that help people maximize their performance, such as nutritional products and, of course, Correct Toes!



How were you introduced to Correct Toes?
Sam found Correct Toes whilst researching plantar fasciitis, which she was suffering from for over a year. They immediately struck a chord – ‘it was as if I’d found a product that I’d already invented in my mind!’ she says. She ordered a pair and had such good results from using them that when we set the shop up, approaching NW Foot & Ankle to stock them was an obvious step.

What results have you seen in your clients and customers using Correct Toes? Which types of people have benefited the most?
The majority of our clients have been barefoot runners and other ‘barefoot living’ enthusiasts – mostly those with injuries or foot problems which are hampering their progress. Often, they’ve tried all the usual channels – they’ve had cortisone injections, or tried orthotics, for example – without success so they’ve been searching for an alternative solution and have become interested in natural foot health. Many customers who have purchased a pair have come back to us to buy a second pair for a partner or friend. We’ve also had pilates instructors, personal trainers and yoga teachers receive the product really well and recommend it to their clients. Here is some customer feedback:

‘Correct Toes have made a real difference to the health of my feet. I wear them every day for pretty much everything. I’m especially impressed by how comfortable they are for running.  I recently completed the annual Man versus Horse marathon wearing a pair.  Despite poor conditions – high water and deep mud – I hardly noticed them.  I wouldn’t hesitate to recommend them.’  

‘I bought Correct Toes because of bilateral plantar fasciitis. It’s been a couple of months since buying them, and my condition has improved. I am not in pain anymore, and can walk about as much as I want. I have not yet returned to running – I will give it a couple more months and then start running barefoot.’

‘I purchased Correct Toes for a possible hallux valgus and have found them to be very successful in treating my ailment.  I have also been using Vibram Fivefingers, massage and exercises.’

An increasing number healthcare professionals, fitness educators, and coaches/trainers throughout the world are incorporating Correct Toes into their practices. Do you see a role for Correct Toes and and its associated natural foot health principles in running, athletics, and coaching?
We definitely believe they have a role to play in helping athletes improve their foot health – especially mobility and strength, which is often lacking in those who wear ‘traditional trainers’ all the time. They can also mark the end of foot pain/problems for runners – including neuromas and plantar fasciitis – allowing them to train more consistently and subsequently achieve better results. People are always interested when Sam takes off her trainers and has Correct Toes on! We think there is scope for so many more runners to benefit – the challenge is getting them to switch into better footwear, that will enable them to accommodate CTs.

Thank you, Sam & Jeff, for sharing your experience, and for helping keep our friends ‘over the pond’ running strong and pain-free!

Capsulitis

 

Image: http://www.healingfeet.com/blog/foot-care/forefoot-pain-could-be-capsulitis
Image: http://www.healingfeet.com/blog/foot-care/forefoot-pain-could-be-capsulitis

Capsulitis is inflammation of a joint capsule. Ligaments surround your joints, including your toe joints, and help form a capsule. Joint capsules help your joints to function properly. Capsulitis is a common problem in certain parts of your body, especially your shoulders and toes. Capsulitis-related inflammation may cause significant discomfort. This health problem can, over time, lead to toe dislocation if it not treated appropriately. In fact, capsulitis is sometimes known as pre-dislocation syndrome. Capsulitis is a condition that can manifest in people of all ages.

Condition Information

Certain parts of your feet and toes may be more likely to develop capsulitis than others. One of the capsules that most commonly experiences this ligamentous inflammation are the capsules surrounding your metatarsophalangeal, or MTP, joints at the ball of your foot. Each foot possesses five MTP joints that connect your toe bones, or phalanges, with your metatarsal bones—long, thin bones located in your mid-foot.

The most common MTP joint capsule to develop capsulitis is the one that connects your second metatarsal bone with your second set of phalanges. Problems with this capsule, especially inflammation, are particularly common, due to excessive pressure placed on this joint during weight-bearing activities. Capsulitis may be difficult to diagnose because of the tendency for other structures in your forefoot to also become inflamed from biomechanical problems.

Causes and Symptoms

Most podiatrists and other healthcare providers believe that capsulitis is caused by aberrant, or unusual, foot mechanics that involve excessive weight-bearing on the ball of your foot beneath your affected toe joint. Certain factors may increase your likelihood of developing this problematic condition, including:

  • Extreme bunion deformity
  • A second toe that is longer than your first toe
  • An unstable foot arch
  • Tight calf muscles on your involved side
  • Imbalance between the muscles on top of and below your feet (extensors and flexors)
  • Regular use of footwear with an elevated heel and/or toe-spring

Conventional footwear may be the most common cause of capsulitis. Most shoes possesses elevated toe boxes, or toe-spring, as a built-in design feature. Toe box elevation increases pressure under the capsules of your MTP joints. Because your second metatarsal bone is usually the longest in your foot, it performs more than its normal share of weight bearing, and it can become inflamed and painful. Tapering toe boxes—another problematic design feature built into most conventional footwear—is another factor contributing to capsulitis. Tapering toe boxes force your big toe against your second toe, putting your big toe out of balance with its corresponding metatarsal bone.

Several distinct signs and symptoms commonly develop in people who have capsulitis, including:

  • Pain in your affected area
  • Swelling around your involved joint capsule
  • Redness of the skin overlying your affected joint
  • The sensation that you are walking on a stone

Painful calluses may form in some individuals if capsulitis becomes a chronic health problem. A person who develops calluses may feel as though the callus has a core or seed inside of them. These calluses are commonly misdiagnosed as plantar warts, and they can occur under any of your metatarsal heads. Capsulitis-induced calluses usually respond to metatarsal pads and cutouts. Cutouts are an orthotic technique that allows your more prominent metatarsal head—one of the structures most commonly affected by capsulitis—to drop lower than your other metatarsal bones. This action helps balance your weight-bearing load and decreases the pressure on your affected area.

Some people with this condition also experience nerve symptoms caused by capsulitis-related swelling. Bursitis—inflammation of fluid-filled sacs located in your forefoot—is another health problem that may be associated with capsulitis or confused with this condition.

Treatment

Capsulitis often responds to conservative, non-surgical treatments. This condition is best treated in its early stages to help improve your affected joint’s stability, reduce your pain and other symptoms, and resolve the root cause of your problem. Common treatment strategies for this health problem include:

  • Rest: Reducing weight-bearing activities can help control your symptoms
  • Ice: Icing your affected area can minimize your pain and swelling
  • Taping or splinting: Taping helps align your involved toe and prevents your toe from drifting
  • Stretching: Stretching may be particularly important for those who have tight calf muscles or foot extensor/flexor imbalance
  • Shoe therapy: Shoes with little or no toe-spring and with wide toe boxes may be most helpful. Also, metatarsal pads placed in your shoe can help return your foot’s fat pad to its rightful, protective location under your metatarsal heads.
  • Anti-inflammatory agents: Supplements or medications can help reduce your pain and swelling

-Dr. Ray McClanahan, DPM, Northwest Foot & Ankle/Correct Toes