Checking client’s shoes prevents future injury

Simple solution solves clinical mystery

By Bruce R. Wilk, PT, OCS

Director, Orthopedic Rehabilitation Specialists


Case history: Jack is a trim, athletic, 40-year-old firefighter. He runs regularly for exercise. Jack’s knee popped on the job while bending to load supplies into the emergency medical truck. He had no previous history of knee pain or injury.

After an orthopedic consultation and imaging studies, Jack had arthroscopic surgery for a torn lateral meniscus. Jack’s workers’ compensation case manager referred him to Orthopedic Rehabilitation Specialists. She realized that even though Jack’s injury was job-related, it was important to look carefully at his exercise routine. She wanted to understand why a physically fit and active person suffered such a serious injury while performing such a routine task.

The first step in determining why an athletic, healthy person suffers an injury without warning is to look carefully at the client’s exercise routine. For runners, the checklist includes the following:

• Does the client follow a good stretching routine before each running session?

• Is the client’s weekly mileage consistent?

• Does the client cross-train appropriately in conjunction with his or her running routine?

If all aspects of the client’s running routine seem to be appropriate and yet the client has suffered an injury, the next step is to take a closer look at the client’s shoes. Jack’s shoes immediately revealed a significant clue to the source of his injury. The heel counter of his right shoe was severely twisted inward, which caused Jack’s foot to roll in excessively, leading to his injured knee.

Close inspection revealed that the heel counter was improperly glued. Jack hadn’t noticed the defect prior to running a race just before his injury. In addition, it rained the day of Jack’s road race, which caused his wet shoes to overstretch and the defect to worsen.

Consider clients’ routines

It’s important for case managers to consider their clients’ walking and running routines. Walking and running often are regular parts of a rehabilitation program. I routinely check my clients’ shoes for defects and often have found problems that cause injury. The incidence of shoe defects has increased recently as more shoes are manufactured outside of the United States. In this case, Jack had run in the same shoes before without incident. In this particular race, however, the rain made the manufacturer’s defect more pronounced.

Checking shoes for defects can save time, money, and prevent needless injuries. Here are some tips for screening shoes for defects that you can pass on to your clients:

• Check the shoes before you purchase them. Put the shoes on a flat surface and grasp the top of the shoe with your hand while rocking it in and out. The shoes should remain even and shouldn’t roll. If they are new and they roll, they won’t stop your foot from rolling from side to side and may buckle during use, causing injury.

• Check to make sure the heel counter is straight. The small stitched rectangular area in the back of the shoe should be straight and sturdy when you hold both shoes at eye level.

• Be sure the midsole of the shoe is securely glued. To test this, hold the shoe and try to separate the upper from the lower of the shoe. If it pulls apart at all, and it’s brand new, it has a defect.

• Check that the upper part of the shoe is glued directly to the sole.

• Check that the eyelets are even.

In addition to purchasing a sound pair of shoes, the client should also continue to check the shoes periodically throughout their use. A good running shoe lasts between 300 and 500 miles. The mileage can be less if the shoe gets wet. Shoes can get wet if a client runs on a treadmill in a warm gym, or if the client runs in the rain. The average runner who runs 25 miles a week with normal wear and tear can expect to have a shoe life of less than 20 weeks. Case managers should recommend that clients put a date on their calendar to remind them when it is time to buy new shoes.

Marathon runners need two pairs of shoes

Marathon runners are a special case. Their mileage increases dramatically while they’re training for a peak race. Also, it’s not unusual for manufacturers to suddenly discontinue shoe models and a shoe which your client is accustomed to running in is unavailable for the big race.

Case managers should recommend that clients buy an extra pair of shoes before a long training program. Remind clients to check the shoes for defects, then recommend that they put on 40 to 50 dry miles on the shoes and then put them away in a closet. That way, the shoes will be broken in but not worn out for the big race, which helps prevent injury.

Even though a client is an active person who runs or walks regularly, case managers must remember that shoe defects may increase the possibility for injury to occur on the job, even during the most minor of job related activities. Case managers must also realize that there may be no pain leading up to the injury to indicate that the onset of an injured knee is imminent.

As for Jack and his defective running shoes, he received 12 weeks of treatment. At the end of that 12 weeks, he competed in a road race with no knee pain. Of course, he first carefully selected a good pair of running shoes.

[Editor’s note: Orthopedic Rehabilitation Specialists is located in Miami. To contact Bruce Wilk, write to: ORS, 8720 N. Kendall Dr., Miami, FL. Telephone: (305) 595-9425. E-mail:]