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Hi all

Just an anecdote to ponder over if you wish. Lady 55 yeras old came for routine chiropody but also complained of right foot medial arch pain when walking in higher heeled shoes i.e. more than 30mm heel. The pain could be elicited and reproduced by palpating the full length of the intermediate band of the PF. In bare feet and flatter shoes there was no pain, even post static.

The STJ axis projected position was rotated about 10dgs to be slightly lateral at the posterior heel projection and slightly medial at the forefoot projection. 1st ray compliant to GRF and 1st MPJ 4mm low relative to lesser MPJs. Hallux rom 65dgs open chain. Unremarkable, average standing foot posture. No rearfoot to forefoot alignment variation. Ankle RoM +10dgs dorsiflexion. Slightly inverted STN.

In barefoot gait she supinated after heel strike and remained supinated thru stance phase including push off, visually the 1st mpj appeared not to touch the floor, in actual fact the right 1st mpj did make contact but GRF here was much lower in magnitude and load rate but similar in time than the left (as indicated by pressure mat scan).



I concluded or surmised that when wearing higher heels she would have earlier forefoot contact, i.e. midfoot strike, and so GRF would tend to pronate the foot more due to the relative position of the STJ axis and the 1st ray would experience higher dorsiflexion moments therefore the PF would be under higher stress and more likely to experience trauma and become symptomatic.

Thought this might be interesting since this is the first case I have come across where PF pain occurs only when wearing high heels, where at first thought one might assume high heels would tend to off load the PF.


Regards Dave