Dr. McNamara's Foolproof Method for Fitting Shoegear

Now that you know what characteristics are important in a shoe to improve biomechanical function of your foot. What about shoe fit? After all if the shoe does not fit correctly then it can not function correctly.

When trying on a new pair of shoes after having vetted them for biomechanical correctness, check the fit by standing and follow the next three steps.

1.) Attempt to place your index finger between the heel counter of the shoe and the back of your heel. This should not be possible! If you can place one or more fingers there then sit back down and seat your heel into the heel counter of the shoe by tapping the heel back against the ground until the heel seats fully. Stand again and continue with step #2.

2.) Next, elevate your big toe in the shoe and determine if there is between 1/4" and 1/2" of distance between the surface of your toes tip and that of the shoes. Any more or less indicates an incorrect fit.

3.) Finally, while still standing, place your thumb to the side of your big toe joint on your shoe and your index finger on the side of your little toe joint. Pull the fabric on the top of the shoe together in a pinching motion. If a wave of pinched material forms as your fingers approach each other and eludes your ability to actually gather and pinch the material, then that is a perfect fit in width. If as pinching no wave of material forms, then the shoe is too narrow. If you are able to pinch any amount of material, then the fit is too wide.

A properly fiited shoe will help you in many ways, not the least of which is avoiding new causes of foot pain.

Keep on being active!

"Cankles" What is their cause?

"Cankles" are an interesting phenomenon. Most women are horrified buy the prospect of developing them and a few have elected to have me remove them. However, once the underlying pathology is understood, conservative measures can be helpful to reduce their size and symptoms.

Cankles are prevalent in women and men (John Madden reportedly has cankles of 38") of middle age. There is an inherited component in that our adipose (fatty) layer of tissue is passed on from our parents. Couple this genetic predisposition with Obesity and the phenomenon worsens. The final insult to the ankle fat pads, of which there are two to each ankle bone, one on the front and the other on the backside of the ankle, is the change in hormones that occurs with the onset of menopause. Every woman that has passed through this point of maturity realizes how their body has changed as particular fat distributions all over their body change shape.
There is one more aggravating factor, fluid retention, as fluid is retained in the lower extremity it gradually stretches these tissues and thus causes them to become larger, which in turn allows these fat pads to accommodate even more retained fluid. Therefore, they appear to grow when in fact they are only increasing their spatial volume.
At a later date I will discuss treatment options!

Shoe Gear That Assists Biomechanical Foot Function

A shoe has to do three things to help the foot function in a generally improved biomechanical manner. The foot has two primary functions, shock absorption at heel strike and propulsion at toe-off.
First, the shoe must fit correctly. I will discuss how to determine correct fit in the next installment!
Second, the shoe should have a rigid heel counter. That is the back, closed-in part of the shoe. This will allow the Sub-Talar joint to be controled in its tendancy to overpronate. Pronation is a normal and neccessary component of shock absorption, but you do not want it to continue into the mid-stance and propulsive phases of gait. You will test for this by putting one or two thumbs on the center of the back of the heel and push as hard as you can. The heel caounter should not deform in the least. If it does the shoe is not good for biomechanical control. It's only good for keeping tacks out of the bottom of your feet.
Third, the big toe joint must be allowed to bend upward as much as 90 degrees very quickly and efficiently to allow effective propulsion. Therefore, the shoe must provide a right angle bend at the precise spot on the shoe that corresponds to your big toe joint when in the shoe. You can test this by placing your open hands, one on the heel and the other on the toe, of the shoe and push them together while looking at the big-toe side of the shoe. The shoe should easily bend at a 90 degree angle at the location of the big toe joint, were it in the shoe. The shoe should not curve into the shape of a "C" or bend in the mid-foot area.
Next Topic: "The Proper Fitting Of Shoes"