You Have Got Pes Planus?

Overview

Adult Acquired Flat Foot

Fallen arches, the medical term for flat feet, are simply feet that do not arch in the middle. Such feet lay flat with the whole of the sole on the ground. All children are born with flat feet, but as they grow the feet normally develop an arch so that by the age of ten almost all children have arched feet. Occasionally a child will not develop properly arched feet. This may be due to a bone malformation present at birth, or abnormalities in ligaments within the feet or legs that cause the child's weight to be unevenly distributed.

Causes

Some people develop fallen arches because they tend to pronate, or roll inwards on the ankles, says the Instep Foot Clinic. Other people may simply have under-developed muscles in their arches. Your arches help your feet bear weight and are supported in this job by muscles and tendons in your feet and ankles. So, while fallen arches aren?t usually serious, they can cause pain in your feet, ankles, knees and/or hips due to your reduced weight-bearing ability. In these cases, treatment may be required. Orthotics that sit in your shoes and support your arches are a common solution, as are exercises to strengthen and stretch your feet and leg muscles.

Symptoms

People will have a very heavily dropped arch and it won?t affect them at all and people will have it slightly dropped and it could cause fierce problems. It could cause things like plantar fasciitis, it could cause heel spurs, desperate ball-of-the-foot pressure, or pressure on the big toe known as the hallux which causes discomfort in the foot. It will create problems upwards to the knees, hips and the back once you?re out of line.

Diagnosis

Your doctor examines your feet to determine two things, whether you have flat feet and the cause or causes. An exam may include the following steps, Checking your health history for evidence of illnesses or injuries that could be linked to flat feet or fallen arches, Looking at the soles of your shoes for unusual wear patterns, Observing the feet and legs as you stand and do simple movements, such as raising up on your toes, Testing the strength of muscles and tendons, including other tendons in the feet and legs, such as the Achilles tendon or the posterior tibial tendon, Taking X-rays or an MRI of your feet.

What is PES Planovalgus deformity?

Non Surgical Treatment

Foot orthotic devices can stabilize some of the causes of flat feet, optimize muscle function and reduce the occurrence of painful symptoms. Generally, a custom-made semi-rigid functional posted orthotic is effective for flat feet. These devices are prescribed based on a thorough biomechanical examination by a qualified chiropodist/podiatrist. Over-the-counter arch supports may be helpful for mild cases, but often prove ineffective to relieve symptoms associated with flatfoot. Wear shoes with a good fit in the arch. Keep active and fit to strengthen leg and foot musculature. Control body weight to decrease load on the feet. Avoid prolonged periods weight bearing with bare feet. Taping to support strained ligaments and joints. Physical therapy modalities such as ultrasound. Referral for surgical correction a severe symptomatic flatfoot.

Surgical Treatment

Adult Acquired Flat Foot

Surgical procedures for flat feet vary depending on the root cause of the condition. Surgical correction to control pronation may include bone implants or Achilles tendon lengthening. Tendon transfer, which is a procedure to re-attach a tendon to another area of bone, may also be used to reduce pronation and improve foot function.
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Heel Aches

Overview

Foot Pain

Does your heel feel painful when you get up from bed every morning, or when you get up after sitting down for a long period of time? If you often experience this sort of pain, known as ?first step pain?, you could be suffering from plantar fasciitis (pronounced fash-ee-eye-tus), an inflammation of the plantar fascia, or the band of muscle under the foot. Plantar fasciitis is the most common cause of heel pain.

Causes

There are many causes of heel pain. However, plantar fasciitis, also known as heel spur syndrome, is the most common, by far. The pain is usually localized to the bottom of the heel towards the inside of the foot. The arch may also be painful. With this condition, pain is typically most severe with the first few steps after a period of rest. The pain my then subside and then return after extended periods of standing. There is usually no specific traumatic event that is responsible for the condition. It is usually the result of overuse, e.g. too much standing, walking or running. There are several common contributory factors such as weight gain, foot type, shoes. Flat shoes or going barefoot are the worst. Athletic shoes are usually the best. The plantar fascia is a fibrous band or ligament that connects the ball of the foot with the heel and helps to support the arch. When this band gets stretched too much or overused, inflammation results, often at the location where it attaches to the heel bone. A heel spur may develop as a result of chronic pulling by the plantar fascia. However, it should be noted that the pain is not caused by the spur. In fact, in some of the most severe cases, there is no spur at all. In other instances, an X-ray may be taken for an unrelated condition and an extremely large but non-painful spur may be seen. Other causes of heel pain include gout, stress fracture, bone tumors, nerve entrapment and thinning of the fat pad beneath the heel. Pain at the back of the heel is usually not plantar fasciitis. (Pain at the back of the heel is often due to an inflammation of the Achilles tendon, enlargement of the heel bone or bursitis.)

Symptoms

Pain in the heel can be caused by many things. The commonest cause is plantar fascitis. Other causes include, being overweight, constantly being on your feet, especially on a hard surface like concrete and wearing hard-soled footwear, thinning or weakness of the fat pads of the heel, injury to the bones or padding of the heel, arthritis in the ankle or heel (subtalar) joint, irritation of the nerves on the inner or outer sides of the heel, fracture of the heel bone (calcaneum).

Diagnosis

Your doctor will listen to your complaints about your heel and examine you to see what is causing the pain, and whether anything else has started it off. If the cause of your pain seems obvious, your doctor may be happy to start treatment straight away. However, some tests may be helpful in ruling out other problems. Blood tests may be done for arthritis. An Xray will show any arthritis in the ankle or subtalar joint, as well as any fracture or cyst in the calcaneum. (It will also show a spur if you have one, but as we know this is not the cause of the pain.) Occasionally a scan may be used to help spot arthritis or a stress fracture.

Non Surgical Treatment

The proper treatment for your heel pain depends entirely on the specific cause(s) of your symptoms. Therefore, it is critical to understand the cause(s) of your symptoms before beginning any treatment program and if you are unsure, then seeking medical advice is essential to develop the proper treatment program for your condition. Some common treatments are listed and can be performed at home. Keep in mind that not all of these treatments are appropriate for every condition, but they usually a good place to start. Rest, reducing activities for a few days can help to reduce the most severe pain. Ice, applying ice to the heel for 10 minutes several times a day will help to reduce inflammation. Stretching exercises, to lengthen the muscles in the back of the leg, including the hamstrings, will help to ease pain, reduce focal pressures to your feet and assist in recovery. For plantar fasciitis, this may be the best treatment of all. Avoid going barefoot, when without shoes excessive stress and strain is placed on the plantar fascia. Proper shoe gear, supportive shoes that fit and are not too worn along with good arch support help to reduce the stress and strain on the plantar fascia over time. Medications, non-steroidal anti-inflammatory medication, such as Motrin (ibuprofen), may help to reduce inflammation. If the pain persists or worsens after a couple of days, an appointment may be necessary where Dr. Talarico may add one or more of these additional modalities to your treatment program. Orthotic b, whether pre-fabricated or custom orthotic is used, these devices can help reduce the underlying structural abnormalities of the foot which have lead to the development of plantar fasciitis. These are often used to limit the recurrence of plantar fasciitis pain. Strapping, a special taping technique to help reduce the strain on the fascia. Injection therapy, in some instances injections are used to reduce the inflammation and reduce pain. Night Splint, this allows you to maintain an extended stretch on the plantar fascia while sleeping. Over time, this has shown to reduce the morning pain which some people experience. Removable Walking Cast, in some case of severe heel pain this may be used to keep your foot immobile for a few weeks allowing it to rest and heal. Physical Therapy may be recommended to aid in pain relief. At The Foot & Ankle Center, PC, Dr Talarico will often utilize two additional in-office modalities, EPAT and MLS Laser Therapy, which are very effective in treating most inflammatory conditions of the foot and ankle, including plantar fasciitis.

Surgical Treatment

It is rare to need an operation for heel pain. It would only be offered if all simpler treatments have failed and, in particular, you are a reasonable weight for your height and the stresses on your heel cannot be improved by modifying your activities or footwear. The aim of an operation is to release part of the plantar fascia from the heel bone and reduce the tension in it. Many surgeons would also explore and free the small nerves on the inner side of your heel as these are sometimes trapped by bands of tight tissue. This sort of surgery can be done through a cut about 3cm long on the inner side of your heel. Recently there has been a lot of interest in doing the operation by keyhole surgery, but this has not yet been proven to be effective and safe. Most people who have an operation are better afterwards, but it can take months to get the benefit of the operation and the wound can take a while to heal fully. Tingling or numbness on the side of the heel may occur after operation.

heel cups for achilles tendonitis

Prevention

Heel Discomfort

You should always wear footwear that is appropriate for your environment and day-to-day activities. Wearing high heels when you go out in the evening is unlikely to be harmful. However, wearing them all week at work may damage your feet, particularly if your job involves a lot of walking or standing. Ideally, you should wear shoes with laces and a low to moderate heel that supports and cushions your arches and heels. Avoid wearing shoes with no heels. Do not walk barefoot on hard ground, particularly while on holiday. Many cases of heel pain occur when a person protects their feet for 50 weeks of the year and then suddenly walks barefoot while on holiday. Their feet are not accustomed to the extra pressure, which causes heel pain. If you do a physical activity, such as running or another form of exercise that places additional strain on your feet, you should replace your sports shoes regularly. Most experts recommend that sports shoes should be replaced after you have done about 500 miles in them. It is also a good idea to always stretch after exercising, and to make strength and flexibility training a part of your regular exercise routine.
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Leg Length Discrepancy Hip Pain Cycling

Overview

Surgery to shorten the longer leg. This is less involved than lengthening the shorter leg. Shortening may be done in one of two ways. Closing the growth plate of the long leg 2-3 years before growth ends (around age 11-13), letting the short leg catch up. This procedure is called an epiphysiodesis. Taking some bone from the longer leg once growth is complete to even out leg lengths. Surgery to lengthen the shorter leg. This surgery is more involved than surgery to shorten a leg. During this surgery, cuts are made in the leg bone. An external metal frame and bar are attached to the leg bone. This frame and bar slowly pull on the leg bone, lengthening it. The frame and bar must be worn constantly for months to years. When the frame and bar are removed, a leg cast is required for several months. This surgery requires careful and continued follow-up with the surgeon to be sure that healing is going well.Leg Length Discrepancy

Causes

Sometimes the cause of LLD is unknown, yet the pattern or combination of conditions is consistent with a certain abnormality. Examples include underdevelopment of the inner or outer side of the leg (hemimelias) or (partial) inhibition of growth of one side of the body of unknown cause (hemihypertrophy). These conditions are present at birth, but the limb length difference may be too small to be detected. As the child grows, the LLD increases and becomes more noticeable. In hemimelia, one of the two bones between the knee and the ankle (tibia or fibula) is abnormally short. There also may be associated foot or knee abnormalities. Hemihypertrophy or hemiatrophy are rare conditions in which there is a difference in length of both the arm and leg on only one side of the body. There may also be a difference between the two sides of the face. Sometimes no cause can be found. This type of limb length is called idiopathic. While there is a cause, it cannot be determined using currect diagnostic methods.

Symptoms

Patients with significant lower limb length discrepancies may walk with a limp, have the appearance of a curved spine (non-structural scoliosis), and experience back pain or fatigue. In addition, clothes may not fit right.

Diagnosis

A systematic and well organized approach should be used in the diagnosis of LLD to ensure all relevant factors are considered and no clues are overlooked which could explain the difference. To determine the asymmetry a patient should be evaluated whilst standing and walking. During the process special care should be used to note the extent of pelvic shift from side to side and deviation along the plane of the front or leading leg as well as the traverse deviation of the back leg and abnormal curvature of the spine. Dynamic gait analysis should be conducted during waling where observation of movement on the sagittal, frontal and transverse planes should be noted. Also observe head, neck and shoulder movements for any tilting.

Non Surgical Treatment

Treatment for an LLD depends on the amount of difference and the cause, if known. The doctor will discuss treatment options carefully with you and your child before any decisions are made. It is important to note that treatment is planned with the child?s final height and leg lengths in mind, not the current leg lengths. Treatment is generally not needed if the child?s final LLD is predicted to be 2 centimeters or less at full height. However, the child should return to an orthopaedic doctor by age 10 for re-evaluation. Treatment is often recommended for LLDs predicted to be more than 2 centimeters at full height. If treatment is done, it usually doesn?t begin until the child starts walking. Possible treatment options include, A ?lift? in one shoe to level the child?s hips. This is often the only treatment needed for small discrepancies.

Leg Length Discrepancy Insoles

how do you get taller in a day?

Surgical Treatment

Surgery to shorten the longer leg. This is less involved than lengthening the shorter leg. Shortening may be done in one of two ways. Closing the growth plate of the long leg 2-3 years before growth ends (around age 11-13), letting the short leg catch up. This procedure is called an epiphysiodesis. Taking some bone from the longer leg once growth is complete to even out leg lengths. Surgery to lengthen the shorter leg. This surgery is more involved than surgery to shorten a leg. During this surgery, cuts are made in the leg bone. An external metal frame and bar are attached to the leg bone. This frame and bar slowly pull on the leg bone, lengthening it. The frame and bar must be worn constantly for months to years. When the frame and bar are removed, a leg cast is required for several months. This surgery requires careful and continued follow-up with the surgeon to be sure that healing is going well.
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What Causes Mortons Neuroma

Overview

plantar neuromaMorton's neuroma, also called Morton's metatarsalgia, Morton's disease, Morton's neuralgia, Morton metatarsalgia, Morton nerve entrapment, plantar neuroma, or intermetatarsal neuroma is a benign (non-cancerous) growth of nerve tissue (neuroma) that develops in the foot, usually between the third and fourth toes (an intermetatarsal plantar nerve, most commonly of the third and fourth intermetatarsal spaces). It is a common, painful condition.

Causes

Morton's neuroma is an inflammation caused by a buildup of fibrous tissue on the outer coating of nerves. This fibrous buildup is a reaction to the irritation resulting from nearby bones and ligaments rubbing against the nerves. Irritation can be caused by Wearing shoes that are too tight. Wearing shoes that place the foot in an awkward position, such as high heels. A foot that is mechanically unstable. Repetitive trauma to the foot such as from sports activities like tennis, basketball, and running. Trauma to the foot caused by an injury such as a sprain or fracture. It is unusual for more than one Morton's neuroma to occur on one foot at the same time. It is rare for Morton's neuroma to occur on both feet at the same time.

Symptoms

The symptoms of a Morton's neuroma are classic in nature. The patient complains of a burning , tingling, slightly numb feeling (dysesthesias) which radiates out to the toes on either side of the interspace that is involved. For instance, a Morton's neuroma of the third interspace will result in pain between the third and fourth toes, and a neuroma in the second interspace will cause pain between the second and third toes. The symptoms are usually aggravated by wearing shoes, particularly those with high heels. Symptoms are relieved by walking in flat, wide shoes or going barefoot. Rarely will the patient experience pain when sitting or laying down.

Diagnosis

The most common condition misdiagnosed as Morton's neuroma is metatarsophalangeal (MTP) joint synovitis. When pain occurs in the third interspace, the clinician may misdiagnose the condition as Morton's neuroma instead of MTP synovitis, which may manifest very much like Morton's neuroma. MTP synovitis is distinguished from Morton's neuroma by subtle swelling around the joint, pain localized mainly within the joint, and pain with forced toe flexion. Palpation of the MTP joint is performed best with a pinching maneuver from the dorsal and plantar aspects of the joint to elicit tenderness of the joint. Other conditions often misdiagnosed as Morton's neuroma include the following. Stress fracture of the neck of the metatarsal. Rheumatoid arthritis and other systemic arthritic conditions. Hammertoe. Metatarsalgia (ie, plantar tenderness over the metatarsal head) Less common conditions that have overlapping symptoms with Morton's neuroma include the following. Neoplasms. Metatarsal head osteonecrosis. Freiburg. steochondrosis. Ganglion cysts. Intermetatarsal bursal fluid collections. True neuromas.

Non Surgical Treatment

Initial therapies are nonsurgical and relatively simple. They can involve one or more of the following treatments. Changes in footwear. Avoid high heels or tight shoes, and wear wider shoes with lower heels and a soft sole. This enables the bones to spread out and may reduce pressure on the nerve, giving it time to heal. Orthoses. Custom shoe inserts and pads also help relieve irritation by lifting and separating the bones, reducing the pressure on the nerve. Injection. One or more injections of a corticosteroid medication can reduce the swelling and inflammation of the nerve, bringing some relief. Several studies have shown that a combination of roomier, more comfortable shoes, nonsteroidal anti-inflammatory medication, custom foot orthoses and cortisone injections provide relief in over 80 percent of people with Morton's Neuroma.Morton

Surgical Treatment

Surgery may be considered in patients who have not responded adequately to non-surgical treatments. Your foot and ankle surgeon will determine the approach that is best for your condition. The length of the recovery period will vary, depending on the procedure performed. Regardless of whether you?ve undergone surgical or nonsurgical treatment, your surgeon will recommend long-term measures to help keep your symptoms from returning. These include appropriate footwear and modification of activities to reduce the repetitive pressure on the foot.

Prevention

To help reduce your chance of developing Morton's neuroma avoid wearing tight and/or high-heeled shoes. Maintain or achieve ideal body weight. If you play sports, wear roomy, properly fitting athletic footwear.
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Chiropodists Favor Shoe Lifts For Leg Length Imbalances

There are actually not one but two different kinds of leg length discrepancies, congenital and acquired. Congenital indicates that you are born with it. One leg is anatomically shorter than the other. Through developmental phases of aging, the human brain senses the step pattern and identifies some variation. The body typically adapts by dipping one shoulder over to the "short" side. A difference of less than a quarter inch isn't grossly abnormal, doesn't need Shoe Lifts to compensate and mostly won't have a serious effect over a lifetime.

Leg Length Discrepancy Shoe Lifts

Leg length inequality goes largely undiagnosed on a daily basis, yet this condition is simply solved, and can eliminate quite a few incidents of back ache.

Treatment for leg length inequality commonly involves Shoe Lifts . Many are very inexpensive, typically priced at less than twenty dollars, compared to a custom orthotic of $200 or even more. Differences over a quarter inch can take their toll on the spine and should probably be compensated for with a heel lift. In some cases, the shortage can be so extreme that it requires a full lift to both the heel and sole of the shoe.

Back pain is the most prevalent condition affecting men and women today. Around 80 million men and women are affected by back pain at some stage in their life. It is a problem that costs employers millions of dollars every year on account of lost time and output. Fresh and better treatment solutions are constantly sought after in the hope of lowering economical influence this issue causes.

Shoe Lifts

Men and women from all corners of the world suffer the pain of foot ache as a result of leg length discrepancy. In these cases Shoe Lifts can be of worthwhile. The lifts are capable of reducing any discomfort and pain in the feet. Shoe Lifts are recommended by countless skilled orthopaedic doctors.

To be able to support the human body in a balanced manner, feet have a vital task to play. Irrespective of that, it can be the most overlooked zone in the human body. Some people have flat-feet which means there may be unequal force exerted on the feet. This causes other parts of the body including knees, ankles and backs to be impacted too. Shoe Lifts ensure that proper posture and balance are restored.

Have I Got Heel Spur

Calcaneal Spur

Overview

Heel spurs (calcaneal spurs) are protrusions (bumps) on the forward underside of the heel bone that can occur when the plantar tendon pulls excessively in the area where it attaches to the bone. The condition is often associated with plantar fasciitis, although it can also occur on its own. Heel spurs typically are not painful unless they intrude into the soft tissue (plantar fascia), where they can cause irritation that results in heel pain.

Causes

A heel spur is a bony overgrowth on the bottom of your heel bone. The heel spur is usually a result of an inflamed ligament (plantar fascia) on the bottom of the foot that attaches to the heel bone. Constant abnormal pulling of this ligament irritates the heel bone and the body lays down a bone spur as a protective mechanism. The patient usually complains of pain with the first step in the morning, some relief following activity, but returning after extended amounts of time standing or walking.

Posterior Calcaneal Spur

Symptoms

Heel spurs often cause no symptoms. But heel spurs can be associated with intermittent or chronic pain, especially while walking, jogging, or running, if inflammation develops at the point of the spur formation. In general, the cause of the pain is not the heel spur itself but the soft-tissue injury associated with it. Many people describe the pain of heel spurs and plantar fasciitis as a knife or pin sticking into the bottom of their feet when they first stand up in the morning, a pain that later turns into a dull ache. They often complain that the sharp pain returns after they stand up after sitting for a prolonged period of time.

Diagnosis

Diagnosis is made using a few different technologies. X-rays are often used first to ensure there is no fracture or tumor in the region. Then ultrasound is used to check the fascia itself to make sure there is no tear and check the level of scar tissue and damage. Neurosensory testing, a non-painful nerve test, can be used to make sure there is not a local nerve problem if the pain is thought to be nerve related. It is important to remember that one can have a very large heel spur and no plantar fasciitis issues or pain at all, or one can have a great deal of pain and virtually no spur at all.

Non Surgical Treatment

Elevation of the affected foot and leg at rest may diminish the pain. Applying gentle heat to the painful area may ease the pain by dilating local blood vessels. One also can protect the heel by placing a foam rubber pad in the heel of the shoe. A pad about one-half inch thick will raise the heel, shift the weight of the body forward, and protect the irritated muscles attached to the heel bone. The same effect can be achieved by using adhesive tape to turn the foot inward. Additional treatment may consist of a number of physical therapies, such as diathermy, ultrasound waves and whirlpool baths.

Surgical Treatment

Heel spur surgery should only be considered after less invasive treatment methods have been explored and ruled insufficient. The traditional surgical approach to treating heel spurs requires a scalpel cut to the bottom of the food which allows the surgeon to access the bone spur. Endoscopic plantar fasciotomies (EPF) involve one or two small incisions in the foot which allow the surgeon to access and operate on the bone spur endoscopically. Taking a surgical approach to heel spur treatment is a topic to explore with a foot and ankle specialist.
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Learn How To Diagnose Heel Spur

Inferior Calcaneal Spur

Overview

The two most common causes of pain in the bottom of the heel, the arch, or both the heel and the arch, are heel spurs and plantar fasciitis. A Heel Spur is a piece of calcium or bone that sticks out from the bottom of the heel bone, and lies within the fibers of the plantar fascia. When walking, the spur digs into the plantar fascia and causes small micro-tears in the plantar fascia. This produces inflammation and pain in the heel, which at times may radiate into the arch.

Causes

Over-pronation (flat feet) is a common cause of heel spurs, but people with unusually high arches (pes cavus) can also develop heel spurs. Women have a significantly higher incidence of heel spurs due to the types of footwear often worn on a regular basis.

Inferior Calcaneal Spur

Symptoms

Some symptoms at the beginning of this condition include pain and swelling, and discomfort when pushing off with the toes during walking. This movement of the foot stretches the fascia that is already irritated and inflamed. If this condition is not treated, pain will be noticed in the heel when a heel spur develops in response to the stress. This is a common condition among athletes and others who run and jump a significant amount.

Diagnosis

A Diagnosis of Heel Spur Syndrome is a very common reason for having heel pain. Heel pain may be due to other types of conditions such as tendonitis, Haglund's Deformity, Stress Fracture, Tarsal Tunnel Syndrome, or low back problems. A more common condition in children is Sever's Disease. The diagnosis is usually made with a combination of x-ray examination and symptoms.

Non Surgical Treatment

In some cases, heel spur pain may not be resolved through conservative treatment options. In those cases, cortisone injections may be used to reduce inflammation associated with the condition, helping to reduce discomfort. However, treatment options such as these must be discussed in detail with your physician, since more serious forms of treatment could yield negative side effects, such as atrophy of the heel's fat pad, or the rupture of the plantar fascia ligament. Although such side effects are rare, they are potential problems that could deliver added heel pain.

Surgical Treatment

Approximately 2% of people with painful heel spurs need surgery, meaning that 98 out of 100 people do well with the non-surgical treatments previously described. However, these treatments can sometimes be rather long and drawn out, and may become considerably expensive. Surgery should be considered when conservative treatment is unable to control and prevent the pain. If the pain goes away for a while, and continues to come back off and on, despite conservative treatments, surgery should be considered. If the pain really never goes away, but reaches a plateau, beyond which it does not improve despite conservative treatments, surgery should be considered. If the pain requires three or more injections of "cortisone" into the heel within a twelve month period, surgery should be considered.

Prevention

Choose new shoes that are the right size. Have your foot measured when you go to the shoe store instead of taking a guess about the size. Also, try on shoes at the end of the day or after a workout, when your feet are at their largest. To ensure a good fit, wear the same type of socks or nylons that you would normally wear with the type of shoe that you are trying on.
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