Another study by orthopedic surgeons showed that 88 percent of
women wore everyday shoes that were too small.
Case History
Jim had seen eight different professionals for his problems.
Because his symptoms were in both knees, most of their thera-
peutic attention was directed there. But it was Jim’s workout
shoes that told the real story. His right shoe had an area where
the large toenail had worn through. Upon measuring his foot,
it was found that his shoes were one entire size too small. “I
thought they should be snug,” he said. After wearing the cor-
rect-size shoes for a week, Jim was able to exercise painlessly
for the first time in two-and-a-half years.You might think that the size of your feet is set by age 20, but
that’s not true. Normal increases in size, as a result of changes in
weight, muscular imbalance or pregnancy, often occur regardless of
age. Just being on your feet a lot can increase their size. This is due to
the stretching or elongation of the ligaments and tendons, followed
by a spreading of the bones in the foot. If you don’t keep up with
these changes by wearing larger-size shoes, you can create a major
physical stress.
Wearing a shoe that’s too small can cause a slow inward jamming
of the toes, characteristically causing a backward subluxation of the
first metatarsal joint, though any toe can be involved. This creates a
mechanical instability in the foot which, if left uncorrected, can lead
to other foot and ankle problems such as hammertoes and bunions. In
time, the toes become spring-like; when a small shoe is slipped on, the
toes spring in, and the tightness of the shoe is not obvious. The first
metatarsal joint, however, is not as flexible as the joints of other toes,
and therefore takes most of the abuse.
Due to the slow onset of this common problem, the first
metatarsal jam is often asymptomatic; if you have it you usually don’t
complain of pain in that first toe joint. But visual examination of your
feet will often reveal trauma, or micro-trauma (long-lasting mild
stress) to the tips of the toes. This often includes discoloration of the
nail bed (a darkened toenail), blistering or callousing of the toes, or
230 • IN FITNESS AND IN HEALTH