Today on the Doc On The Run podcast, we’re talking about how to lace your running shoes when you have extensor tenosynovitis.
If you get pain on the top of the foot when you’re running and either you’ve watched some YouTube videos, you’ve been to see a doctor, or you just listened to some podcasts about this topic and you figured out that you have this thing on the top of your foot causing pain, called extensor tenosynovitis. It means you have irritation and inflammation in the tendon sheath, or the little tube that surrounds the tendons on the top of the foot.
How does that happen? Well it happens two ways. So if we look at your foot and you look at the tendons that come down the top of the foot, well, they’re sitting over all of these bones that you have in your foot and all those bones, what they are doesn’t really matter, but you have a tube that goes around the tendons so that it can slide through the sheath and not get irritated.
If the tube gets inflamed, because you lace your laces too tight and you compress the tendon sheath between the bone and the shoes, it gets irritated and inflamed and you develop this thing called extensor tenosynovitis, where you get all this inflammation, it’s swollen, it’s painful, it’s red. It hurts. It hurts when you move your toes. It hurts when you run. It hurts when you put your shoes on, that’s extensor tenosynovitis.
To get it better you have to decrease the inflammation around the tendon sheath. You have to stop irritating it and the easiest way to do that is to stop putting all the pressure right on that spot. Now, usually this happens where you have some kind of prominence, there’s a bone sticking up, a bone spur, a little lump in the bone, whatever, something that’s putting more pressure there.
So how do you fix that? This is actually pretty simple. When you look at the lacing pattern on your shoes, what you do is you put your shoes on and you think about where the laces go. So again, this is not rocket science, but it’s going to be very, very helpful. So when you take your shoe laces and you look at the lacing pattern, what you’re going to do is you take your finger and you poke around on the top of your foot and let’s say you figure out that your most painful spot, where that tendon sheath is, where the tube’s going underneath there and irritating it, that you figure out it’s right here. Well, you want to remove the spot of pressure away from there by altering the lacing pattern in your running shoes and the way you do that is you look at your shoe laces and you undo the top several laces to get to below this spot.
What you have is you have intact these laces here. So then what you do is in this spot, as soon as you get to where you know this painful spot is, you want to skip that hole. So you’re going to go up here. Then you’re going to skip this hole. So you’re going to go from the lacing pattern, you’re going to go over the hole to this one, over the hole, to this one, and then you’re going to continue upward and when you do that and you lace it in that way, you’re actually leaving a space open so that you no longer have pressure right there and that makes a tremendous difference.
So if you take your running shoes, you put them on, you push around the top of the foot and you find the spot. You will usually find that it is right where these laces cross and so if you have a spot where the laces are crossing and right underneath that is where your painful spot is, that’s where you need to skip the hole. You don’t want to do it everywhere. Obviously you don’t want to have a whole bunch of them missing. You just want to do it on one.