"THE FITTED SHOE"

For over 35 years, a leader in orthopaedic shoes for the whole family. Tom is a graduate Orthotist from the Olive Harvey - Northwestern University Rehabilitation Institute of Chicago program. If you have a question, we will be happy to try and answer it for you. e-mail tom@fittedshoe.com

DREW SHOE

BAREFOOT FREEDOM - FOOT SAVER

ARTHRITIS

Arthritis is a chronic disease that affects joints. There are over 100 variations of this pathology. Arthritis can affect the young, middle age adults, as well as the elderly. Although most many may find this problem a minor inconvenience, others will find it as a crippling, painful and activity limiting. For these, the problem gets worse with each passing year and if neglected, the deformities may also increase, thus further limiting the patients activities and enjoyment of life. For more information you might find this site interesting: http://arthritisinsight.com . I will not try to explain all the types and treatments for this problem because I just am not educated enough in this area, instead I will go on to what I do know - shoes.

SHOES AND ARTHRITIS

Arthritis is an on going and progressive type of disease. However, it often has a habit of hitting one set of joints, causing inflammation, then regressing and jumping to another area or coming back to the original site. A lot of things go into this mixture. How active your are, repetitive joint wearing motions, your metabolism, genetics, medications or their lack and other things like shoes, the type of hosiery you wear.

The inflammation tends to move into joints that are already under stress. Workers may get it in their backs, athlete's in their knees and shoulders, or the elderly, everywhere. Women who wear pointed toe shoes, high heels, flats and loafers to short or nylon hose, often get it in their toes and the balls of their feet. As pointed out in the other sections of foot problems, flat feet, pronation and supination can also cause foot joints to be under stress and inflammation can result that leads to forms of arthritis.

Your body is constantly putting on and taking off bone. Arthritis has a tendency to break down joints while the body in an effort to heal itself views the inflammation with alarm and secretes hormones that are drawn to the inflammation site which draw calcium out of the blood stream to put on additional layers of bone to heal and protect the inflammation site. This causes spurs and enlarged joints which irritate easier, cause more inflammation, draw more hormones, which draw more calcium, which makes the joints larger which irritate easier and around and around you go.

Cortisone shots, aspirin and other medications are given as temporary efforts to calm down the inflammation. They do not stop the cause of the irritation or make the problems go away. They treat the symptoms and attempt to break the pain and inflammation cycle.

During this cycle, the foot and it's joints are very susceptible to change and deformity. Nylon hose or tight sox that draw on the toes or pull them together can over time help the joints to mold themselves in this bunched condition. The results can be hammer toes, adducted big toes, overlapping toes and other deformities.

Over the years, I have asked arthritis patients to exercise their toes straight. A little at home physical therapy, five to ten minutes a day. It does not cost them $50 an hour, like at the hospital and keeps the joints loose and movable. I have found that allowed to sit, flexion contractures of the tiny ligaments and muscles often occur, then the joints attacked by arthritis and held in a flexed position, tend to reform bone (in the putting on bone stages) and lock the joint in the flexed position. This then causes callous formations under the ball of the foot as the metatarsal phalangeal joints are pressed down and break down the metatarsal arch. Corns and callous formations also appear on the top on the toe joints where they hit and rub the toe box of shoes.

From experience, I find the best results are in shoes that have more support and more toe room. In depth shoes with oblique toes seem to work best. Barefoot Freedom's Fitter, Sally and Stroller or P W Minors Miss Contour or Duchess. These shoes are more straight last and are built like your foot, with more height, ball of the foot space and are shaped like a natural foot. The orthopaedic counters and double steel shanks lock you upright or in anatomical position. This prevents the foot from twisting and turning over, thus limiting stress on the joints. The in depth features allow more room for toe deformities and the wider ball area accommodates bunions. The shoes also have cushion soles and cushion innersoles to take stress off the ball of the foot and heel. For active walkers and workers, Fitter with it's vibram sole is even better, because the sole will absorb more impact and allow less impact stress to the foot.

In cases of tremendous deformity or where the joints are totally locked; P W Minor has created Heidi and Ava for women and a new shoe for men. These shoes are slightly less support than the standard orthopaedic in depths and double depths, but have a unique stretchable upper that conforms to every deformity and takes all pressure off the joints. The slightest pressure causes the upper to give and mold to the problem joint. Normally, patients with this much deformity are a lot less active and the softer shoe allows them more comfort and less stress than from any other shoes made.

At times, custom orthotics may be designed or ordered by your physician. These shoes are all in depths, so the stock cushion innersole can be removed and your custom insert or orthotic added without loss of heel fit or comfort. The new orthotics for arthritis are often several layers of various density plastizote or other cushion materials. The softest layer is often against the foot, with denser layers below. The top layer often bottoms out or compresses with body weight over time. The time will vary with your size and activity levels. This top layer may have to be replaced or relined as necessary by your doctor or orthotist who made them.

This aside, you may still need some additional help. If your toes rub or put too much pressure on a joint, you may need to have a shoe customized. Shoe stores and shoe repairs have a ball and ring affair than can stretch a shoe at one small place to accommodate a hammer toe or bunion. If you have a pin point problem, the factory did not know about it so they did not last in an attic apartment or side room for your joint. However, one can be put there for you within a few minutes if necessary. Often I hear people say, the new shoe is just not as comfortable as the old shoe. I have to laugh and agree. The old shoe has been molded with perspiration and body heat for a year to accommodate every enlarged and deformed joint. The new shoes do not have any of these custom bubbles in the leather when they are new. We can take the break in out by strategically stretching the leather over the affected joint. In my opinion, it is better to correctly fit the feet and stretch for the deformity rather than fit big for the deformity and have the feet floating in the shoes. Friction is your enemy and if you are sliding around, you will irritate the arthritic joints and pay the price with more inflammation, pain, enlarged joints and more deformity next year. Better to just soften the problem area and fit the feet correctly. A local shoe repair can also stretch a shoe for you to accommodate your deformities.

Another problem is the misguided use of leaving the laces untied or extremely loose. This allows the foot to slide in the shoes and cause friction and will normally irritate joints. Also, the feet will swell more with loose shoes than correctly and snugly tied shoes. The walls of the shoes and laces act like a corset and push the edema or swelling out of the foot. You will still swell ankles up, but your feet will stay down if tied correctly. Left loose, the swelling will increase to fill the volume of the shoe and may put pressure on the capillaries, preventing the switch from arterioles to venules, thus increasing swelling and further breaking down the vascular networks in the feet. More swelling may decrease an effective oxygenated blood supply to the feet and further the destruction mechanisms of arthritis or diabetes by increasing pressure and pain.

In summery, the answer seems to be your prescribed medications, exercise to keep the joints limber and straight as possible (this may be painful at times but better than letting the joints lock in a deformed position), and shoes that hold you straight, prevent twisting, cushion the foot and give plenty of toe and ball of the foot room to prevent rubbing, and soles that absorb impact or heel strike shock while walking. Your doctor will watch the medications and perhaps prescribe custom orthotics which will be used in the same shoes. So if you are not comfortable, consult your doctor. There should be some combination of shoes, arch supports and medications that can help you be comfortable and stay active. If you have any shoe questions, contact me at tom@fittedshoe.com .

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DREW BAREFOOT FREEDOM - FOOT SAVERS - P W MINOR - FITTED SHOE