PEDORTHIST. A pedorthist is a foot care specialist, trained specifically in gait analysis, shoe fitting, foot orthoses, custom shoes, wound care and lab fabrication.
–From the Foot Mechanics website
The Injury Cycle
Injuries to the foot, knee, leg or hip can be vexing problems for people who run and ride. Figuring out why the injury happened or keeps happening is not something you can often do on your own.
Two winters ago was not a difficult time in terms of weather where I run and ride in Illinois. There were some icy days, but I did credit a persistent calf injury to a slippery run on roads covered with snowy slush. The leg did not hurt so much when I rode the mountain bike, nor on the road bike when the weather cleared sufficiently to take out the Felt 4C.
The calf would clear up slightly and then cramp without warning. It seemed like cold weather had something to do with it, but not always.
Come spring I was out for a gentle 4-miler at a local running trail when the calf tightened yet again. Hobbling back to the trailhead, I sat down on a bench and watched as other runners trotted home happy and healthy. Not wanting to feel sorry for myself, I started up conversation with some people stretching and talking near the water pump. Then two big white dogs came up and they were so irresistibly furry it was impossible not to pet them. I asked the owner’s permission and she said, “Sure, they like attention.”
We started talking, the pet owner and I, and before long conversation turned to my running and the persistent injury. She invited me over to a picnic table sitting on a concrete slab and had me take off my shoes. Her friend took one look at the rigid orthotics inside my shoes and said, “Hoo boy.”
“What?” I asked.
“You’re in trouble now,” she chuckled.
Running into good luck
It turned out my new friend with the white dogs was none other than Shelley Simmering, a pedorthist and owner of Foot Mechanics, a medical practice at 303 N. Route 31 in St. Charles, Illinois. By no mere coincidence, her shop is right next door to a local running institution, Dick Pond Athletics, provider of running shoes for more than 40 years.
Following an on-the-spot examination of my lower leg and ankles, Simmering invited me in for an appointment to figure out what was going on with my calves, because truth be told, both legs were really bothering me.
The appointment started with a long discussion of running history that included going way back into a career as a high school and college athlete, what events I did in track and field, and how my current running program has evolved.
That took a while. Runners like to talk about themselves, you know. Simmering took notes and gathered information for her assessment all the while. Her listening powers appear to be a key component of her overall effectiveness in working with runners and cyclists looking to cure and prevent injury.
After the examination, Simmering had me hop up on a treadmill for a videotaping session. The camera went to work recording my full posture and running form as well as closeups of my gait and lower legs in action. Simmering literally marked the lower legs with inked lines and angles, helping her find and determine what kind of torque and stresses were at play in the legs.
Then she set up my feet with some podiatry tape that turned into plaster, the cast for a set of future orthotics. Before letting me leave, she provided some temporary lifts and a whole catalogue and demonstration of proper stretches for my tweaking calves.
The Whole Truth and Nothing But the Truth
The return appointment to review the videotape was enlightening, to say the least. Back in the 1980s I had worked with a renowned podiatrist whose work with world-class runners like Sebastian Coe, Craig Virgin, Jim Spivey and Mike Durkin helped those athletes compete at a global level. I even illustrated the book he wrote about foot and leg mechanics.
But nothing prepared me for the lesson I was about to get from Shelley Simmering as she played back the videotape she’d made of my stride. She let me watch a few moments and said, without irony: “You do know you’re crooked, don’t you?”
I could see that. The stride I’d carefully crafted over thousands of miles depended on a fairly pronounced compensatory swing of the right arm to maintain momentum. It was clear my hips were not level either, and one leg might be a little longer than the other, she told me.
That videotape was a depressing piece of evidence why I might be having some issues. “You’ve got a great stride, actually,” she informed me. “I’d personally like to see you shuffle more than you do, but I can tell you were a middle distance runner, used to going fast. It’s just that things have settled a little more than you might think. With age and the like.”
She pointed out moments in my stride where my body was working really hard to compensate for bio-mechanic deficiencies. I’d known that for many years and really focused on maintaining good form however possible. Yet uneven wear on my left heel told me that my footstrike was uneven, as did a circular motion under my right forefoot. Like a three-legged dog, I’d learned how to move fast in spite of any physical deficiencies.
After depressing the hell out of me with the videotape, Shelley Simmering smiled and waved off the challenges, then added a few more. “You’re not the most flexible runner I’ve seen, particularly in your ankle flexion. That may be the cause of some of your calf pain, along with some known pronation, which we’ll examine here.”
Then she played back the videotape isolating the view of my lower legs and there, in full slow motion, one could see the visible stresses being placed on my calves as I ran barefoot on the treadmill. It was clear you could stick those feet inside shoes and the problems would still occur. You could even put orthotics inside those shoes and the problems would still be there.
So I asked, “What can we do?”
Her first observation was that there appeared to be as much stress in the forefoot as around the ankle. My current orthotics made no compensation for that motion, and as a mid-foot striker, it was obvious why that might cause some problems.
The appointment concluded with some encouraging words and Simmering sent off for some orthotics according to her instructions.
Like getting new feet
When they came back, we went next door to buy brand new shoes tailored to the new orthotics. Those shoes weren’t cheap. And the consultation with Simmering was $600, and needed to be submitted with a special letter to the insurance company to seek coverage. Most insurance companies are still struggling to justify preventative medical procedures, and pedorthists like Shelley Simmering do not fall into the easy categories mapped out by insurance companies.
All I can tell you is that the orthotics, given a couple weeks to adjust, have worked relative wonders in my running. Cycling is different for me, and there have not been any problems resulting from my cycling form and motion patterns. But running was definitely difficult before treatment. Now I’m running 4-5 times a week with only occasional calf tension, which we’re adjusting with tweaks and time.
Honestly, Shelley Simmering saved my running hopes from oblivion. Things were not going well. Now they are. It’s worth checking out whether you’ve got a pedorthist near you if you have any running or riding problems due to bio-mechanical issues. If you like to run and ride, you ought to invest in your own health and injury prevention.