07/13/2022    Andrew Cassidy DPM, MS

Metatarsal Stress Fractures and Under Armour Shoes (David H. Long)

I see multiple sports injuries a day including
stress fractures. I feel that we have not really
addressed the true issue is that most of athletic
shoes, including 98% of sports cleats are poorly
constructed. I look for 3 basic tenants in shoes:
1: Stiff Heel Counter. 2: Stiff shank in the shoe
which makes the shoe bend like a foot (novel idea).
And the third is a wide enough toe box in width and
depth. None of these issues address pronation. The
only shoes that do this are a few good running
shoes. So even the best cleat/ tennis/ basketball
shoe does not address pronation and therefore needs
a good orthotic.

I see a lot of pediatric stress fractures and it is
often a mixed etiology of bad shoes / overtraining
/ and not enough Vitamin D / calcium. These kids
get branded at a young age by Nike / Under Armor /
Adidas and now the high schools are usually
sponsored by one shoe company or the other. For one
of the local state championship football teams in
my area Nike landed a helicopter on the field to
give them their shoes for the championship game.
These shoe companies are marketing companies first
/ clothing companies second and shoe companies a
distant third. Lastly these poorly designed shoes
are part of the etiology of other injuries like ACL
tears, hip and back issues.

The current focus in shoe development is weight and
design more than function. I had a conversation
with the head Nike shoe designer for one of their
golfers and I asked him why they don’t have shanks
in the shoes; his answer was cost. They have one
golf shoe with a shank and it is the one Tiger
wears and it is hard to find. As foot/ ankle
specialists we need to educate our patients more on
shoes.

There are a few exceptions to the rule and I have
made a shoe list that every new patient leaves my
office with. It takes a few more minutes but they
get better faster and stay pain free over the long
haul. We also have a video on website on how to
evaluate shoes. Plus with kids, I feel good shoes
and definitely a good custom orthotic they can push
their ontological development in a better alignment
as they grow and potentially have less proximal
issues in the future. Teach you patients to put
pressure on these companies with their wallets
where it hurts them the most.

Andrew Cassidy DPM, MS, Austin, TX

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