Do the Shoes Fit?

By Ian Smith, M.D.

A few months ago I teamed up with several Harvard friends to compete in New York City's first Ivy League Alumni Basketball Tournament. Except for an occasional jammed thumb or sprained ankle, I've never been prone to sports injuries, and when both my large toes began aching midway, I did what many athletes are trained to do: I gritted my teeth and played through the pain. By the end of the day, it hurt just walking to the car. When I took my shoes off, I noticed blood under my toenails, a troubling sight even for a physician. Just touching them caused excruciating pain.

I was suffering from a common sports injury. Variously called black toe, jogger's toe or tennis toe, it's characterized by bleeding under the toenail as a result of repeated trauma. I'd worn thinner socks than usual, which left room for my feet to slide forward, banging my nails many times against the front of the sneaker, or so-called toe box. Shoes that are too big or slippery can create the same problem.

The experience showed me just how easy it is to injure your feet. According to the American Academy of Orthopedic Surgeons, 43 million Americans have foot problems, costing $3.5 billion a year in treatment and lost workdays. Yet like my injury, many are avoidable if you choose the right footwear for a particular activity.

Start by examining one of your sneakers on a flat surface. If the heel is worn more on the inside than the outside, you're a pronator. That means you roll your feet inward each time your heel strikes the ground. You need a control shoe specially built to counteract this tendency. If your heel is worn more on the outside, you're an underpronator, which means you ought to wear a shoe with more cushioning.

As a rule of thumb, if you do something three or more times a week, you need a sport-specific shoe. The exceptions: basketball, running and aerobics. These always require special shoes, regardless of how often you participate in them. Basketball and aerobics, in particular, involve frequent lateral movement, demanding shoes that give you good stability. Look for a sneaker with a high back (or profile) that will keep your foot from rolling over. Otherwise you'll risk painful ankle sprains and torn ligaments and tendons.

Many people assume it's all right to walk in almost any shoe because it's not as demanding as running. Not true, says Dr. Carol Frye of the orthopedic academy: "Walking shoes should be at least 2 1/2 in. thick in the heel area, giving you comfortable cushioning, and have a rocker-sole design that encourages the foot's natural roll as you move."

Runners need even more cushioning because they're constantly pounding their feet. The front of their shoes should be flexible, because runners tend to push out with each stride. It also helps if the outer soles have deep, wide treads, preferably lightweight.

When you're trying on sneakers, do it 30 min. to 1 hr. after you've exercised so that the foot is still fully expanded. Always wear the sort of socks you'll be wearing during the sport, and check that you have a thumb's width--about 1/2 in.--of space between the tip of your toes and the front of the sneaker, giving enough room to wiggle them.

These pointers might have helped me avoid my bloody nails. And winning the tournament might have eased the pain. But we didn't win: Brown did, which made the pain even worse.

Visit the American Academy of Orthopedic Surgeons at www.aaos.org You can e-mail Dr. Ian at ianmedical@aol.com