Step 1: Try to find someone reliable. I live a pretty transient life right now, so I don't know any providers in my area. So I went online to a specialty running shop's website. They had a list of recommended providers. Perfect.
Step 2: Schedule an appointment. Easy enough.
Step 3: Prep for the appointment. I tried to pay closer attention to the pain in my foot; tried to figure out when it hurts and why and if I can make it better. The night before, I also tossed all three pairs of my running shoes in a bag to lug with me. The different shoes do affect how my foot feels and I thought the wear patterns might be a useful bit of information.
Step 4: Review expectations. I knew what I wanted to get out of the trip. I wanted to describe my pain, talk about my assumption that I have tendonitis from tying my shoes too tightly, but explain tying them more loosely leads to blisters, talk about why different shoes might give me different pain, and hopefully get some advice as to what running shoes might be best for me.
Step 5: Confirm appointment and ask cost for the recommended "1 Hour Biomechanics Assessment." Learn the cost of the appointment includes the price of a set of custom orthotics. Naively think nothing of it.
Step 6: Go to the appointment.
At the appointment, before I said anything, I took off my shoes and socks. The podiatrist commented on the number of calluses I have and how curled my toes are (which is apparently due to tight tendons across the top of my feet). I said, oh, yeah, that makes sense, when I run I sometimes have pain on the top of my right foot.
And I think that's all I said about the pain. She manipulated my foot a bit and pressed on it asking if it hurt. It didn't. It only hurts when I run. I didn't actually get the chance to point to the specific location that I have pain or even to describe the pain. Instead, "the pitch" started.
The podiatrist was a kind lady and she explained things in a very simple and easy to understand way. She also very clearly believes in what she is doing. But even before the assessment began, she started selling the custom-made orthotics as the ONLY fix.
Then I got on the treadmill and walked slowly for maybe five minutes. At the end she told me I overpronate and that my right foot is worse than my left. I agree that my right foot is the issue, it's the only foot pain I have (as she knew) and my only other injury is also on my right (which she does not know about - I might have mentioned it, but I never got the chance).
"The pitch" continued and it was emphasized that I have a skeletal issue and there's no way to fix it except to get orthotics and wear them every day for the rest of my life. I pointed out that I brought my running shoes and got one out to show her. She didn't look at the bottom, but pointed out that the top looked as though it was pulled to the left as in the photo.
I didn't feel comfortable pointing out that was likely because I had three pairs of shoes smooshed into a single bag. Below is what my shoes looked like immediately after my run tonight. To get it to look pulled over (as above), I had to push on the top.
So I sat through the rest of the appointment and had plaster casts made of my feet.
Step 7: Leave appointment. Think, "What just happened?"
I am not the type of person to question someone who is supposed to be more knowledgeable than me and I generally dislike confrontation. But I left the appointment feeling off about it.
For one, I've had my gait analyzed by running store employees and a physical therapist numerous times. I have always been told I have a fairly neutral gait. I've never even been told I pronate at all, let alone as badly as the podiatrist said. The podiatrist asked, "Oh, have you rolled your ankles many times?" as if the answer was an obvious yes. And while I know many female athletes who are chronically rolling their ankles, I never have.
Next, I didn't get the chance to describe my pain. I wasn't asked what the pain felt like or what actually caused it. The nuances of my particular case seemed entirely superfluous, which I guess I should have expected since the prescription (custom-made orthotics) was decided before I walked in the door.
The assessment was based only on slow walking. I do not have, nor have I ever had, pain while walking. That includes many miles of backpacking with a heavy pack. I cannot believe that my foot mechanics are exactly the same when walking and running and since I came in for a running injury, a diagnosis based on running data would have been nice.
Lastly, she didn't care to look at my shoes. I can't imagine making a diagnosis while ignoring readily-available data.
Step 8: Try to google it.
Yeah, I know: don't google diagnose. But at least my own internet guided opinion is based on all of the available information for my case. You might say, "Go get a second opinion," but I can't afford that. This appointment wasn't cheap and I live on a grad student salary, which is plenty to live on, but not enough to go blowing on specialist appointments.
The first thing I wanted to look at was the wear pattern on my shoes. If I do over-pronate, then I think I should see wear along the inside of my shoes, perhaps especially on my right shoe. I didn't see that, though. Here's what I did see (and forgive my the dirty shoes, I had a wet run and nowhere to wash them off).
The top is my right shoe and the bottom is the left. While I'm not trained to look at shoes, I did notice that neither shoe looks particularly worn on the inner ball-of-foot area. By the way, these shoes have nearly 280 miles on them, so they should be pretty reliable.
On the left is my left shoe and the right is my right. This is the outer edge of my shoes. It seems obvious to me that the wear on the outer edge of my right foot is more extensive than on my left. I fail to understand how that could align itself with the idea that I over-pronate with my right foot. If anything, I think my right foot maybe supinates more than it ought to.
Again, left on the left, right on the right. At the toe of my shoe, I think it looks again like I push off more on the outside of my right foot than my left foot. I'm just not convinced that I pronate.
Step 9: Decide to wait and see.
Maybe the orthotics will help relieve the pain so that my marathon training isn't affected. But I do not believe there is a single solution to any problem, especially when the problem was not actually taken into consideration. I don't think I pronate, but I think there's a slight chance orthotics will help anyway. I don't know. Maybe when I make more money I'll go see another specialist and see what they think.
In the meantime, I'll be looking into foot and ankle strengthening.
