Looking for recommendation for a neutral, orthotics-friendly shoe for someone with high arches which does not have alot of forefoot flexion. I have a bone spur on the top of my right foot near the big toe that can get inflamed from rubbing against the big toe tendon when my forefoot has to flex too much (running on sand and/or uneven terrain + sometime on real long runs). Any recs will be greatly appreciated.
thanks,
Jack
That is what a Morton’s extension on an orthotic is supposed to do (i.e. limit the great toe/1st MPJ dorsiflexion). Hopefully, this was addressed by the “professional” who made your orthotic? Or, were you using them for another reason?
The gf was recommended the Brooks Addiction 8 for use with her orthotics, primarily because it has less than average flex. She has been very pleased with this shoe.
Newton – Distance (green) or Gravity (orange).
Even though there is a wide flex groove in front of the lugs, the main flex of the shoe comes from the arch area; I would say that the forefoot flex is not at all pronounced.
They are comfortably spacious, and I think would accommodate orthotics easily.
For the bone spur on the top of your foot, I cannot think of a better show than Newtons. The mesh upper is very soft and pliable, and there are no overlays in the area of the toes.
Actually, the orthotics were to deal with a pronation issue with my LEFT achilles - without orthotics that leg pronated in a way that caused me problems with the inside of my achilles tendon, particularly when I upped my mileage for IM training. With the orthotics that issue is totally gone. The orthotics I have are the white-semi-hard foam kind (you step in a foam box and that outline of your foot is used to make the orthotic) - they really control the my heel/instep but there is nothing to them in the front.
I got the orthotics from a sports podiatrist in NYC who works with lots of IMers + ultrarunner types and seemed to know her stuff. Also, to be fair, I was not having this bone spur issue at the time I got them. My problem now is that I have recently moved overseas (Netherlands) and have no idea where to go for someone who really knows their stuff re sport medicine, podiatry in particular. That’s why I was hoping I could try for a shoe with less forefoot flexion to deal with the issue (now using Saucony Rides which are otherwise good). I am training for the Paris Marathon in April but I am also concerned about the issue long term - right now I can run with minimal discomfort unless I go too long or too much on sand/uneven terrain, but I want to be running 20 years from now and this does not seem to me to be a thing that will get better on its own. Given the above, any advice would be GREATLY appreciated.
Gotcha’
What you can do then is attach a stiff “piece” of thin steel, carbon fiber, etc about 3-4 cm wide (depending on the size of your foot) and 8 cm long or so under the great toe, extending past the 1st MTP joint to the underside of your orthotic. It is OK if it is a little “thicker” as well (the Morton’s extension) as this will help to effectively load the 1st MPJ before the rest of the forefoot, thereby limiting its dorsiflexion (and then pain). You don’t want to lock out too much forefoot motion as that can predispose to a lesser metatarsal stress fracture (a very common running injury).
Thanks alot for the advice - been looking for someone here to make me such an orthotic with no luck. Strange as there are tons of runners and running races here. Not too sure about building my own as I am no professional and can imagine myself with the metatarsal stress fracture you mention trying to do it on my own (found it tough tough carbon fibre/steel piece to fit specs anyway). Was thinking about two other options: 1) keeping my current orthotic in my left shoe for the pronation issue but switching to a stiff store-bought superfeet insole in the right of the big toe (I have a pair of superfeet in my cycling shoes); 2) switching to trail running shoes even for road running so I get less flex in the forefoot. Also wondering if there is any way to get orthotics made long distance. Any additional advice would be much appreciated - at this point I am having no pain/issues on 5-7 mile runs, but there is a noticeable lump in the tendon where it has rubbed and it does get irritated when I go longer. It hasn’t been painful in a week but the lump is still there.
The Mizuno Creations are neutral without a lot of flex. They were my shoe of choice for running with PF, as the midfoot flexion is pretty controlled.
I’ve done a few orthotics “long distance” for prev pts or those that have old ones, but honestly it doesn’t work very well this way since I have to rely on your capture method, lack of X-ray and clinical exam, etc.
When you say a noticeable “lump” in the tendon, do you mean the extensor hallucis longus (can google) or is it on top of the great toe joint itself (google hallux rigidus)?
I had a sesamoid bone removed from my right foot. so I can’t have a lot of forefoot flex either. I found the PI Synchro Guides to have the stiffest sole I could find. I don’t think they are a neutral shoe but if you’re going to use orthotics it may not matter.
On top of the joint, even slightly in front of it toward the end of the toe - you can really notice the lump when I flex (dorsiflex?) the toe so that the tendon is more visible on top of the toe. The spur that it is rubbing against when my foot flexs on impact is not really visible but you can feel it right next to the big toe joint toward the middle of the foot (its bony bump you can feel there that I don’t have on my other foot). Does this give any more insight as to what my next steps/best options/longer term outlook should be? Not sure if the lump is permanent, if the lump is itself a big problem to worry about.
thanks again,
Jack
The exostosis (spur) on the joint itself won’t go away and will slowly get larger. This will continue to limit the dorsiflexion of the joint causing pain. Often, it will also break off and become a “joint mouse” as well. This requires either a “cheilectomy” surgery or possibly a hemi-joint implant (I don’t like total great toe joint implants as they don’t work well and don’t last long) or even a fusion of the joint in severe cases.
The fibrosis of the EHL tendon is likely from the tendon being irritated by the underlying spurring.
Wow, that sounds really, really bad. What’s the thing to do in the short term - is it smart to try to have surgery sooner before it gets bigger or wait as long as possible? Also, is the damage to the tendon permanent? At this point the toe itself can flex as much as the big toe on the other foot and I can still run without issue most of the time, its just when it fully flexes the rubbing occurs. Still, I’d rather do whatever is best for long term health (ie running in 20 years).