I find myself transfixed these past couple days. There's an excellent article in last month's National Geographic (yes, I'm just now catching up on that reading) that opened my eyes to a new element of what I do professionally.
The article is based on footwear, and what it means to us as humans. It's functionality. It's fashion. It's ways of demonstrating to others who we are and what we signal to others about our status and self-actualization. Among the different article segments, some really touch one's heart. Such an event occurred during my reading.
What struck me most concerned the thoughts and philosophies of an ultra high-end shoemaker, named Olga Berluti. She had a personal epiphany regarding feet when she was a school girl at an Italian convent. She would pray before a 14th century portrayal of Christ's crucifixion, and her eyes were always leveled upon the nails securing Jesus's feet to the cross. In it, she saw pain. She also saw a means of releasing pain in others. She said to herself, "When I am older, I will remove the nails. I will relieve the suffering of men's feet."
She also shares her idealogy of footwear: "Shoes adopt and tame you, and you adopt and tame them, like domesticating a wild animal," she says. "You buy a pair of shoes you adore, but they are too edgy, too avant-garde. Perhaps your wife made you buy them. You put them away, and little by little this style, this color you're not used to seeps in. You buy a jacket that goes with them, or a different color shirt. One day, you realize you have become the man your wife envisioned. The shoes revealed something new, something unexpected in you."
She further relates: "Feet are spiritual. They enable man to stand up. They free his hands. Now, he can look at the stars."
Those words burned through me as if they were some sort of stigmata. While treating patients, I always try to accomplish three things: relieve pain, improve function, and provide ambulatory freedom. I see myself as a healer, through my own specified skills. Now, I see things quite clearer and more powerfully. Perhaps, in my own inter-spiritual way, this is my means in administering stewardship through God. Maybe by helping people both feel relief from their discomfort and improve their sense of well-being, I am also helping them reach closer to their better selves. This new thought process brings with it a higher sense of self in me, too. Humbly so.
Olga Berluti custom made men's oxford with a decorative scar element
*Today, my wife and I decided to switch and do a guest post for one another's blog, so this post is written by my wife - Sparkling Diamond *
So, would you like to know whats its like as a woman to be married to Shoe Guy? I'm gonna let you know. But, I'm going to refer to what its like in regards to the topic of shoes (well, of course that would be my topic here!!)
Before I tell, I have to admit, I'm not like most women who are obsessed with shoes. My sister got those genes. I'm more of the practical jeans and t-shirt gal and even when young didn't love wearing high heels. As a matter of fact, when I was a bride's maid at a friends wedding when I was only 19, I discovered that while wearing her required heels, when I had to bow my head and close my eyes for the prayers, I would almost fall over. Me & heels - not made for each other.
That aside, I am one of those who did a big no-no when young and am now paying for it. I spent most of my time barefoot, then spent 7 years walking, jumping and running on concrete pool decks without shoes. Next were several retail jobs where I spent all day on my feet on barely carpeted cement floors. The results? Well, really, really screwed up feet that hurt all the time!
Mind you, my feet don't look deformed...they are very pretty (as seen in the header graphic above) but they are royally screwed up.
So, I guess you could say that indeed, my prince in shining shoe know-all armour arrived to rescue me.
He has taught me the do's and don'ts of shoe shopping and has helped to 'fix' my feet.
Ok, back to what I wanted to share in this post. Here is how things go in our home when I need shoes.
Me
Getting dressed in dressy chocolate brown pants) Grrrr...hunny, I have no brown shoes to go with anything brown!
Shoe Guy: OK, what are you wanting?
Me: Well, you know I like Mary Janes. I don't want anything super dressy, just something I can wear with my nicer brown items...dress pants or skirts.
Shoe Guy: OK
A few days later he comes home with several boxes of shoes. They are always from the best shoe makers. They are perfectly suited for my foot probs and since shoe guy is also a shoe addict and knows what a good looking shoe looks like, they are beautiful.
He will also drag me into the shoe store we have downtown which carries all of the top brands and have me show him which styles I like.
Yes, ladies, its not fair. I live with my own personal shoe shopper (who also loves to help me clothes shop...but thats another story)
Yesterday was one of those days. We were walking around downtown and he pulled me into TOPS and made me look at a lot of shoes. I did find a brand I thought was adorable called Miz Mooz and I tried on numerous shoes with him watching fully attentive and giving feedback.
We left there and on our way to the art supply shop (which is where I wanted to go) he pulled me into a dress shop and made me look through racks of way to high priced beautiful clothes and talked to me about how I needed to wear these at my art shows.
NO, this is not a dream or hallucination...this is real. I must have been really good in my last life, or something. I am a woman who is married to a man who loves shoes and clothes. Sometimes when we are out shopping, I have to laugh and love the looks we get from those standing around us because this is what they will hear:
Me: Hunny, are you done? Can we please go home now?
Shoe Guy: Just a few more minutes dear.
Me: I'm tired and I really don't need this gorgeous black leather skirt you picked out for me...can we just go?
*Insert here: sounds of the nearby women fainting and falling to the floor.*
I've often considered renting him out during the holidays......
I get questions virtually every day about what makes a good shoe for diabetics. The truth is just wearing shoes consistently is a good start. However, there are elements within certain shoes which make certain models better than others. The good news for many is that a shoe doesn't have to lack visual appeal in order to be appropriate wear for those with this condition.
The first thing is why are special shoes needed? As the effects of diabetes work it's ravages agianst the body, one of the first things to be limited in function is nervous activity at the extremities. With nerves not working at a healthy capacity, soft tissue and bones within the foot can break down. In worst cases, the arch completely collapses and the foot's shape becomes a rocker bottom. In other words, the arch is now the lowest part of the foot's profile, instead of the heel. This diminishing nervous health also can lead to the foot's inability to feel unwanted objects or debris lodged against the foot. Sometimes these even become unknowingly imbedded into the skin. More often an open wound is created. Also, a person suffering peripheral neuropathy starts to feel less stable on their feet, since they cannot feel signals well enough from down below. While a properly fitting and well constructed shoe won't cure nerve damage from diabetes, it will limit the effect of symptoms.
When Medicare provides shoes and inserts under the Therapeutic Shoe Bill, it is done in the hope of extending the best possible health for diabetic, neuropathic patients. In order for a shoe to be approved for use under this program, the shoe manufacturer must submit a sample to SADMERC for thier inspection. According to the Bill, the first thing that must be achieved is an appropriate amount of depth within the shoe to accomidate both the foot and an insert of minimum 3/16" thickness. This thickness is dictated by the prescription from Medicare for the type of insert they want provided inside the shoe. There are some shoes which meet or exceed the requirements made by Medicare that do not have SADMERC approval. Although these shoes will usually not be paid through the TSB, they are certainly acceptable for us by diabetics not currently on Medicare.
Here are some things to look for in any shoe appropriate for this use:
A. I can't relate enough just how important depth is. Make sure that there's room for the toes to move and breathe. It's also not a bad idea to check for any amount of soft padding in this vamp area, or for some type of soft brushed material inside to reduce friction to the tops of the toes.
B. and C. Look for ample amounts of padding at the top of the tongue and around the collar. This also reduces the risk of shear and blistering. At the back of the collar, some people prefer an achilles notch to better hold the heel; for some others, this notch aggrivates their foot. It's really just personal preference with this.
D. This piece, here is extremely important. Any good shoe (for diabetics or otherwise) should have some sort of supportive counter imbedded around the heel. At the bare minimum, it should be leather or molded fiber board. It's best to have a molded plastic counter. You can check the quality by squeezing that part of the shoe with your fingers. If it flexes easily, you might want to consider a different model. Should the insides touch completely, discard the shoe immediately.
E. Here's another example of that depth I described. The inlay should be removeable. Most shoes without a removeable feature will more than likely also lack other important construction elements. Once removed, look at how thick the inlay is towards the toes. Like mentioned earlier, 3/16" is the minimum; 1/4" is even better. There are even shoes that have greater depth than that, or have multiple inside layers. These are great for adjusting fit and accomidating pressured or painful areas of the foot. What's nice now is that there are a lot of shoes currently available which hide some of that depth into the outsole of the shoe, so you don't end up with one of those really boxy looking things.
F. The shank is another critical part of the shoe's construction. It directly relates to how stable the shoe will be, and will greatly extend the shoe's functional life. The best shoes still use steel as their shank material. These days, companies are also using thermopastics and tuck boards to accomplish it's necessary demands. Regardless of what it's made of, be sure the shoe has something performing it's important job. Here's an easy test. Holding the heel counter of the shoe in one hand, and wrapping the other hand across the outsole toe area, give the shoe a twist. If it twists easily, you shouldn't even consider wearing it. In addition to placing the foot in a position to create a functional deformity, it also puts the wearer at a much greater possible risk of both a severe arch collapse and forefoot ulcers. A little bit of twist (maybe 5-10 degrees) or none at all is most desired.
G. The outsole also contributes a lot to what the wearer can expect in both comfort and stability. The first important element is to check for a flared sole. What that means is that when looking at the shoe from behind the heel, the sole flares outward (wider at the base than at the shoe's upper). If it flares in, discard the shoe. It will, in time, create more problems than benefits. Outsole materials also determine their ability to absorb shock and maintain durability. Most shoes approved by SADMERC use either EVA or polyurethane. Here's a quick guide between the two:
EVA light and cushioned
hardness can be altered to make it more stable or more cushioned
not extremely durable; wears out faster, the softer it is
Those people whose heels tend to roll out should avoid this kind of sole construction
The Reebok Princess is a good example of a basic, EVA sole
PU a little heavier compared to EVA
hardness can also be altered
extremely durable, even in it's softest formats
extremely stable, both for those whose heels roll inward or out
SAS shoes are good examples of PU construction
So, remember, you don't have to wear a shoe that looks like this in protection of diabetic fee (unless you really want to):
Otherwise, you can get both good health and good looks:
More and more, with the continued relaxed fashion sense in our current society, people are turning to flip flops for acceptable footwear. These are no longer even just for summer; people here in the NC mountains even wear them year round. The obvious appeals are that they are light, airy, and CHEAP. No wonder it's a favorite among students. Add the usual lack of any support with the hard surfaces many of us walk upon, then hoist those heavy back packs for those heading back to class, and you start getting a lot of people with early foot pain. Here are some tips on what to look for in these kinds of products.
The typical thong sandal is a simple cut foam block with some sort of strap to hold the sandal to the foot. This is the cheapest technique, and start off extremely soft and cushy. That sensation then fades fairly quickly as the foam underfoot compresses. This slow death of the sandal starts the very first day they are worn, with some flattening completely in the matter of a few short weeks. If we all walked on grass and other soft surfaces, this shoe breakdown wouldn't be that big of a deal for most wearers. With concrete, marble and blacktop all about us, the shock from those hard surfaces start to penetrate the sandal only to be absorbed by our bodies. Sometimes we can hack it; other times those repetitive forces start to slowly wear us down. 
There are some soft foam thongs which place an arch cookie into the inside half of the sandal; however, most of those I have seen have that support inserted into the wrong space. In looking at the skeletal foot, the apex of the arch is usually not in the center of the foot. It's located just in front of the ankle, under a bone called the navicular. So having an asymmetrical cookie with the higher part of it towards the heel then sloping gradually towards the toes is far more reliable in providing anatomical support. Birkenstock is a common example of a sandal (and yes, some thongs too) which employs this. The trade off for many people is that Birk's idea of arch volume is very aggressive on their personal arch shapes. 
Here's a great example of something properly molded, yet not too aggressive on the foot. It accomplishes three things:
-The heel is cupped so rather than the tissue in our heel totally spreading apart and limiting our ability to absorb shock, it cradles the heel in a soft supportive position
- It contours to support the lateral arch (yes, there's one on the outside half of the foot, too). It's apex is also just in front of the ankle.
- Finally, the shape swings back to the inside half to support our medial arch. All of this is done without taking away the normal gait function we want to have in our feet. 
Then, here's an example of the finished product. So we've met our criteria of something protecting our feet from all those hard, nasty surfaces we frequently find ourselves on. It's light and airy, as we like. With the additional tooling required to make a sandal like this, you won't acquire a pair for that WalMart special $5. But to me it's not unreasonable to lay out $40 or $50 for a thong that will last years, and help make sure the time we are on our feet is time without pain or discomfort.
By the way, the sandal pictured above is from a new brand called Olukai. I came across them at a recent trade show, and was extremely impressed by their quality and accurate reproduction of an average foot. They aren't the cheapest, but in my odyssey of finding oustanding footwear they are certainly the best thong sandals available. I'm planning on buying a pair once we get towards warmer weather again. I'm not one of the Asheville, permenant-beach residents. It does snow here, after all! Now does this mean I have to buy a pair for Sparkling Diamond, too? And the three offspring??
Several years ago one of my most trusted vendor reps showed me this interesting new product he was newly repping. It was this one-piece foam clog from a company called Waldies. I remember that what impressed me originally was that I felt it would be a tremendous improvement over slippers, socks and barefeet for those patients of mine suffering from heel pain. Unfortunately, my boss and colleague felt that it didn't fit him perfectly and therefore wouldn't be effective at the practice. Years later, he's been proven quite wrong.
Now, there are hoards of similar-looking products out there. The company that started Waldies was better known for constructing kayaks, and apparently had no idea just how cut-throat people in the footwear industry can be. Whether they failed to file for a proper patent, or didn't have the resources to protect their unique design from those companies so willing to copy it, Waldies is now a fairly small player in this footwear category.
But are all these look-alike clogs just as good? In my experience, looks (especially in this arena) are very misleading.
First, let's start with how these things are made. As long as a manufacturer has a mold, they can select any foam of their choosing, get it hot enough to inject into the mold, then sell the things to their hearts' desires. That's where the similarity ends.
You see, it's not what the clog looks like that makes the difference, it's what foam is used to make it. Picture a material that contains billions of little sealed chambers. Something like that is light, extremely cushioned, and tremendously durable. So durable that it's memory will spring back each and every time you remove it at the end of the day. With closed cell polyethelene, that's how Waldies manages to make a clog that is still the best I have come across.
There are lots and lots of foams that can liquified enough for the injection process. Most all of them are far less expensive than closed cell PE, so the copy brands end up using these and either rake in higher profits or sell an inferior clog at a cheaper price. The worst are the open cell EVA foams. Although also very light and soft, they have no memory. So they start breaking down and flattening the very first time someone starts wearing them. This progressively gets worse until they become pretty much unwearable.
Fortunately, all these products are cheap (especially in comparison to the cost of a well-made shoe). It really does pay to try different brands to find the one that makes your feet their happiest. Maybe you'll be like me (and my wife, kids and patients) and find that there truly is a superior difference with Waldies.
If you've never heard of the original product, you can see more at www.waldies.net. Have happy feet!
And yes, they do look dorky. But they feel soooooooo good!
It's funny. Many who practice pedorthics enter the profession due to their own foot pain. This is true with myself, as well. My first bout was back while managing a specialty shoe retail shop in downtown Baltimore.
It was a typical holiday season, and also just as typical I was on my feet constantly. The decision I later rued was wearing a pair of Christmas decorated Converse Chuck Taylors. They had Christmas trees scattered about the white canvas, and replaced the usual white laces with a red ribbon. Cute, they were. Attract attention, most certainly. They were also a quick and effective way to garner my first bout with plantar fasciitis.
My heel hurt like hell for several weeks, even after changing to more appropriate footwear. I also did myself in by wearing shoes which were at least a full size shorter than I should have donned. With abyssmally narrow feet, many times I had to go shorter just to hold my heel in the shoe. In addition to chronic ingrown toenails, over the years I developed a nice case of metatarsalgia. I couldn't even cook a family dinner (barefoot in the kitchen, as was my behavior in those days) without the balls of my feet screaming at me.
These days, as my wife reminds me on a regular basis, I am a total and complete shoe snob. I not only admire and crave impeccably constructed shoes; I insist that everyone in the family own footwear proper for their own feet and use.
Although I help others with their foot pain on a daily basis within a clinic, and offer free assitance on other websites, I am here to spread the good word further. Few things are as aggravating and debilitating as limping around with bad feet. Hopefully, as readers here, you'll find things that will interest you. More importantly, I hope that those who are suffering find relief from what I post.
Let's all defeat bad feet!
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