Lacing Techniques for a Proper Fit

Although the width, length, and size of your shoes are important, many people forget that lacing techniques are equally of value to ensure a proper fit. Many lacing techniques can be used to prevent injuries and to relieve foot problems and pain. Individuals with specific foot issues should follow lacing techniques specific to their foot characteristics to get a good shoe fit.

General Lacing Techniques:
Follow these general techniques from The American Orthopaedic Foot and Ankle Society:

• Loosen the laces as you slip into your shoes because this prevents unnecessary stress on the eyelets and the back of your shoes.


• Begin lacing your shoes closest to your toes, and pull the sets of eyelets, one at a time to adjust laces for a perfect fit.


• Shoes with a large number of eyelets make it easier to adjust laces for a custom fit.
  

Specific Tips for Shoe Types:

• Narrow feet: Start with the eyelets farthest from the tongue of the shoes and bring it up the side of the shoe.


• Wide feet: Use the eyelets closest to the tongue of the shoe because this provides for more space.


• Heel problems: By using every eyelet, make sure that the area closest to the heel is tied very tightly, while less tension is held near the toes. When you have reached the second to last eyelet on each side, start threading the lace through the top eyelet, making a small loop. Then, thread the opposite lace through each loop before tying it.


• Narrow heel and wide forefoot: Use two laces and thread through the top half of the eyelets and the other lace through the bottom half. The laces closest to the heel should be secured more tightly than the lace closest to the toes.

The High Price of High Heels

The idea that high heels can be hazardous to your health isn't new—orthopedists have warned women for years that high heels can contribute to the development of a variety of conditions from corns and calluses to hammertoes, arthritis, chronic knee pain, sprained ankles and back problems.

In 1998, a team of Harvard researchers linked high heels and knee osteoarthritis, a painful, degenerative joint disease characterized by the breakdown of the cartilage surrounding the knee. In that study, D. Casey Kerrigan, MD, associate professor of physical medicine at Harvard Medical School, and her team looked at very narrow, stiletto heels.

Later, researchers decided to look at the chunkier heels now in fashion to determine if they too are harmful to women's knees. The study demonstrates that wide heels increase the risk of developing osteoarthritis in the knee as much as, or more than, thin-heeled stilettos.

"Wide-heeled shoes give you the perception of more stability when you're standing, and they feel comfortable, so women wear them all day long," Kerrigan said. "They are better for your feet than stiletto heels, but just as bad for your knees."

"It takes a long time to feel the effects of knee osteoarthritis, and once you do, it's too late," said Dr. Kerrigan.

Eighty percent of the 42 million Americans suffering from arthritis have osteoarthritis, in which joint cartilage and surrounding bone progressively degrade from wear and tear. Surgeons perform over 300,000 artificial knee replacements in this country every year due to this condition.


High heels can also result in a variety of other foot problems, including metatarsalgia, which is pain in the ball of the foot. Another condition, called Morton's neuroma, which is 10 times more common in women than men, is caused by a thickening of tissue around a nerve between the third and fourth toes. It usually develops in response to irritation and excessive pressure such as the weight burden high heels place on the ball of the foot. Pointed toe shoes and shoes that pinch lead to other foot problems such as bunions, calluses and hammertoe.

Information from the Health Library at the Yale-New Haven Hospital

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Foot Care Myths Revealed

"Step on a crack and you'll break your mother's back."
Growing up we believed this and other old wives' tales or myths. We found them to be quite funny. But there are other myths that are no laughing matter, especially when they involve your health.

From bunions to broken bones, doctors with the American College of Foot and Ankle Surgeons (ACFAS) have heard it all. Here is a small collection of myths about foot care and the realities behind them.

Myth: It can't be broken, because I can move it.
Reality: This widespread idea has kept many fractures from receiving proper treatment. The truth is that often you can walk with certain kinds of fractures. Some common examples: Breaks in the smaller, outer bone of the lower leg, small chip fractures of either the foot or ankle bones, and the often neglected fracture of the toe.

Myth: Applying an elastic bandage to a severely sprained ankle is adequate treatment.
Reality: Ankle sprains often mean torn or severely overstretched ligaments, and they should receive immediate care. X-ray examination, immobilization by casting or splinting, and physiotherapy to ensure a normal recovery all may be indicated. Surgery may even be necessary.

Myth: Cutting a notch (a "V") in a toenail will relieve the pain of ingrown toenails.
Reality: When a toenail is ingrown, the nail curves downward and grows into the skin. Cutting a "V" does not affect the growth of the toenail. New nail growth will continue to curve downward. Cutting a "V" may actually cause more problems and is painful in many cases.

Myth: The terms 'fracture,' 'break,' and 'crack' are all different.
Reality: All of those words are proper in describing a broken bone.

Myth: Shoes cause bunions.
Reality: Bunions are most often caused by an inherited faulty mechanical structure of the foot. It's not the bunion itself that is inherited, but certain foot types make a person prone to developing a bunion. While wearing shoes that crowd the toes together can, over time, make bunions more painful, shoes themselves do not cause bunions.
Although some treatments can ease the pain of bunions, only surgery can correct the deformity.

Myth: If you break a toe, immediate care isn't necessary.
Reality: A toe fracture needs prompt attention. If X-rays reveal it to be a simple, displaced fracture, care by your podiatric physician usually can produce rapid relief. However, X-rays might identify a displaced or angulated break. In such cases, prompt realignment of the fracture by your podiatric physician will help prevent improper or incomplete healing. Often, fractures do not show up in the initial X-ray. It may be necessary to X-ray the foot a second time, seven to ten days later. Many patients develop post-fracture deformity of a toe, which in turn results in a deformed toe with a painful corn. A good general rule is: Seek prompt treatment for injury to foot bones.

Myth: Corns have roots.
Reality: A corn is a small build-up of skin caused by friction. Many corns result from a hammertoe deformity, where the toe knuckle rubs against the shoe. The only way to eliminate these corns is to surgically correct the hammertoe condition.
Unlike a callus, a corn has a central core of hard material. But corns do not have roots. Attempting to cut off a corn or applying medicated corn pads can lead to serious infection or even amputation. A foot and ankle surgeon can safely evaluate and treat corns and the conditions contributing to them.

Myth: I can't get skin cancer on my feet.
Reality: Skin cancers can occur anywhere on the body, regardless of sun exposure. Foot and ankle surgeons recommend routine foot self exams to spot suspicious moles, freckles and other spots on your feet that show the signs of melanoma.

Myth: If you have a foot or ankle injury, soak it in hot water immediately.
Reality: Don’t use heat or hot water on an area suspect for fracture, sprain, or dislocation. Heat promotes blood flow, causing greater swelling. More swelling means greater pressure on the nerves, which causes more pain. An ice bag wrapped in a towel has a contracting effect on blood vessels, produces a numbing sensation, and prevents swelling and pain. Your podiatric physician may make additional recommendations upon examination.

Myth: Duct tape can remove a plantar wart.
Reality: Although there are many folk remedies for warts, patients should be aware that these remain unproven and may be dangerous. Patients should never try to remove a wart themselves - this can do more harm than good.

Myth: Putting cotton under an ingrown toenail will relieve the pain.
Reality: Cotton placed under the nail can be harmful. It can easily harbor bacteria and encourage infection.