What is Dupuytren’s contracture. How does it affect hand function. What are the risk factors for developing this condition. Can Dupuytren’s contracture be treated effectively. What are the available treatment options for managing Dupuytren’s disease.

Understanding Dupuytren’s Disease: A Comprehensive Overview

Dupuytren’s disease is a progressive condition affecting the palmar fascia, a layer of fibrous tissue beneath the skin of the palm and fingers. This condition leads to the thickening and contraction of the fascia over time, potentially causing the fingers to bend inward towards the palm. The resulting deformity, known as Dupuytren’s contracture, can significantly impact hand function and daily activities.

The exact cause of Dupuytren’s disease remains unclear, but genetic factors are believed to play a crucial role. While some anecdotal reports suggest a link between hand injuries and the development or worsening of the condition, scientific evidence supporting this connection is limited. Similarly, there is no conclusive evidence that overuse of the hand causes Dupuytren’s disease.

Key Characteristics of Dupuytren’s Disease

• Gradual thickening and contraction of the palmar fascia
• Formation of nodules and cords in the palm
• Progressive bending of fingers towards the palm
• Potential impairment of hand function

Recognizing the Signs and Symptoms of Dupuytren’s Contracture

Dupuytren’s contracture typically develops slowly over several years. Identifying the early signs and symptoms is crucial for timely intervention and management. Here are the primary indicators to watch for:

1. Nodules: Small, firm lumps in the palm of the hand
2. Skin changes: Pitting or dimpling of the skin near the nodules
3. Cords: Thickening of tissue, forming rope-like structures under the skin
4. Limited finger movement: Difficulty fully extending or spreading the affected fingers
5. Contractures: Permanent bending of fingers towards the palm

Are certain fingers more commonly affected by Dupuytren’s contracture. The ring and little fingers are most frequently involved, although any finger, including the thumb, can be affected. The condition may impact one or both hands, with varying degrees of severity.

Risk Factors Contributing to Dupuytren’s Disease Development

While the exact cause of Dupuytren’s disease remains elusive, several risk factors have been identified that may increase an individual’s likelihood of developing the condition:

• Gender: Biologic males are more susceptible than biologic females
• Ancestry: Northern European and Scandinavian descent increases risk
• Genetics: Family history of Dupuytren’s disease
• Age: Increased incidence with advancing age
• Alcohol consumption: Potential association with Dupuytren’s development
• Medical conditions: Higher prevalence in individuals with diabetes and seizure disorders
• Hand trauma: Possible link to injury or surgery, though evidence is inconclusive

Can lifestyle modifications reduce the risk of developing Dupuytren’s disease. While some risk factors, such as genetics and age, cannot be changed, maintaining overall hand health and addressing modifiable risk factors may potentially help. However, more research is needed to establish definitive preventive measures.

Diagnosing Dupuytren’s Contracture: Clinical Evaluation and Assessment

Accurate diagnosis of Dupuytren’s contracture is essential for appropriate management and treatment planning. Healthcare providers typically rely on a combination of clinical examination and patient history to diagnose the condition:

Physical Examination

• Visual inspection of the palm and fingers
• Palpation to identify nodules and cords
• Assessment of finger flexibility and range of motion
• Tabletop test to evaluate the severity of contracture

Patient History

• Onset and progression of symptoms
• Family history of Dupuytren’s disease
• Impact on daily activities and hand function
• Presence of associated risk factors

Is imaging necessary for diagnosing Dupuytren’s contracture. In most cases, a clinical examination is sufficient for diagnosis. However, in some instances, imaging studies such as ultrasound or MRI may be used to assess the extent of tissue involvement or to plan for surgical intervention.

Conservative Management Approaches for Dupuytren’s Disease

In the early stages of Dupuytren’s disease or in cases with minimal functional impairment, conservative management strategies may be employed to slow progression and maintain hand function:

Non-Surgical Treatment Options

1. Observation and monitoring: Regular follow-ups to track disease progression
2. Hand therapy: Stretching exercises and splinting to maintain flexibility
3. Steroid injections: Potential to reduce inflammation and slow nodule growth
4. Radiotherapy: Low-dose radiation treatment in early-stage disease
5. Enzyme injections: Collagenase injections to break down cord tissue

Can conservative treatments cure Dupuytren’s contracture. While these approaches may help manage symptoms and slow progression, they do not provide a permanent cure for the condition. The effectiveness of conservative treatments varies among individuals, and some patients may eventually require more invasive interventions.

Surgical Interventions for Advanced Dupuytren’s Contracture

When conservative measures fail to provide adequate relief or in cases of severe contracture, surgical intervention may be necessary to improve hand function and quality of life. Several surgical options are available, each with its own benefits and considerations:

Surgical Techniques for Dupuytren’s Contracture

• Fasciotomy: Dividing the contracted cord without removing tissue
• Fasciectomy: Surgical removal of the affected fascia
• Dermofasciectomy: Removal of affected tissue and skin grafting
• Needle aponeurotomy: Minimally invasive technique to divide cords

What factors influence the choice of surgical technique. The selection of the most appropriate surgical approach depends on various factors, including the severity of contracture, the specific fingers involved, the patient’s age and overall health, and the surgeon’s expertise. A thorough discussion with a hand specialist is crucial to determine the best treatment plan.

Rehabilitation and Recovery Following Dupuytren’s Treatment

Successful management of Dupuytren’s contracture extends beyond the initial treatment. A comprehensive rehabilitation program is essential to optimize outcomes and maintain hand function:

Key Components of Dupuytren’s Rehabilitation

1. Hand therapy: Customized exercises to improve flexibility and strength
2. Splinting: Use of custom-made splints to maintain finger extension
3. Wound care: Proper management of surgical incisions to prevent complications
4. Scar management: Techniques to minimize scarring and promote tissue healing
5. Gradual return to activities: Phased reintroduction of daily tasks and hand use

How long does recovery take after Dupuytren’s treatment. The duration of recovery varies depending on the type of intervention and individual factors. While some patients may experience rapid improvement, others may require several months of rehabilitation to achieve optimal results. Consistent adherence to the rehabilitation program and follow-up with healthcare providers is crucial for long-term success.

Living with Dupuytren’s Disease: Long-Term Management and Prognosis

Dupuytren’s disease is a chronic condition that requires ongoing management and monitoring. Understanding the long-term outlook and adopting strategies for daily living can help individuals maintain hand function and quality of life:

Strategies for Long-Term Management

• Regular hand exercises to maintain flexibility
• Protective measures to avoid hand injuries
• Adapting daily activities to accommodate hand limitations
• Periodic follow-ups with healthcare providers
• Staying informed about new treatment developments

Can Dupuytren’s contracture recur after treatment. Recurrence of Dupuytren’s disease is possible, even after successful treatment. The rate of recurrence varies depending on the initial severity, treatment approach, and individual factors. Ongoing monitoring and early intervention for signs of recurrence are essential components of long-term management.

In conclusion, Dupuytren’s contracture is a complex condition that can significantly impact hand function and quality of life. While there is no definitive cure, a range of treatment options and management strategies are available to help individuals maintain hand function and adapt to the challenges posed by the disease. By working closely with healthcare providers and adhering to recommended treatment plans, many people with Dupuytren’s disease can achieve improved hand function and maintain their ability to perform daily activities.

Dupuytren’s Disease – Dupuytren’s Contracture – OrthoInfo

Dupuytren’s disease is a condition that affects the palmar fascia — the fibrous layer of tissue that lies underneath the skin and above the tendons, nerves, blood vessels, and bones in the palm and fingers.

In patients with Dupuytren’s, the fascia thickens and contracts (shortens) over time. The fascia may pull on the fingers during this process, causing them to be forced inward, toward the palm. This may make it difficult or impossible to fully straighten the fingers, resulting in what is known as a “Dupuytren’s contracture.”

In some people, a worsening Dupuytren’s contracture can interfere with hand function, making it difficult to perform daily activities. When this occurs, there are nonsurgical and surgical treatment options available to help slow the progression (worsening) of the disease and improve motion in the affected fingers.

The fascia is a layer of tissue that helps to anchor and stabilize the skin on the palm side of the hand. Without the fascia, the skin on your palm would be as loose and moveable as the skin on the back of your hand. In patients with Dupuytren’s disease, this palmar fascia gradually thickens and contracts (shortens).

Dupuytren’s is usually first detected when lumps of tissue, or nodules, form under the skin in the palm. This may be followed by pitting (deep dents) on the surface of the palm as the diseased tissue pulls on the overlying skin.

A Dupuytren’s contracture. The patient cannot fully extend his ring finger because of the tethering effect of the cord-like structure in his palm.

As Dupuytren’s gets worse, bands of fascia in the palm develop into thick cords that can tether (lock) one or more fingers and the thumb into a bent position. This is called a “Dupuytren’s contracture.” Although the cords in the palm may look like tendons, the tendons are not involved in Dupuytren’s.

In many cases, a Dupuytren’s contracture progresses (gets worse) very slowly, over a period of years, and may remain mild enough that no treatment is needed. In moderate or severe cases, however, the condition makes it difficult to straighten the involved digits. When this happens, treatment may be needed to help reduce the contracture and improve motion in the affected fingers. Typically, as a contracture worsens, the involvement of the fascia becomes more severe, and treatment is less likely to result in a complete correction.

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The cause of Dupuytren’s disease is not completely known, but most evidence points toward genetics as having the most important role.

There are anecdotal reports (based on personal accounts) of Dupuytren’s developing or worsening after a person experiences an injury or an open wound (including surgery) to their hand; however, there is no good evidence to support this. There is also no convincing evidence to suggest that it is caused by overuse of the hand.

Risk Factors

There are many factors that are believed to contribute to the development or worsening of Dupuytren’s disease. These include:

• Gender. Biologic men are more likely to develop the condition than biologic women.
• Ancestry. People of northern European (English, Irish, Scottish, French, and Dutch) and Scandinavian (Swedish, Norwegian, and Finnish) ancestry are more likely to develop the condition.
• Heredity. Dupuytren’s often runs in families.
• Alcohol use. Drinking alcohol may be associated with Dupuytren’s.
• Certain medical conditions. People with diabetes and seizure disorders are more likely to have Dupuytren’s.
• Age. The incidence of the condition increases with age.
• Trauma. Dupuytren’s disease may appear and/or worsen after trauma —including surgery — to the hand.

A Dupuytren’s contracture typically progresses (gets worse) very slowly, over a period of years. Signs and symptoms of the condition may include:

Nodules. You may develop one or more small lumps, or nodules, in the palm of your hand. These nodules are typically fixed to the overlying skin. Initially, the nodules may feel tender. Over time, this tenderness usually goes away. In some cases, there can be “pitting,” or deep dents, in the skin near the nodules.

Cords. The nodules may thicken and contract, contributing to the formation of dense and tough cords of tissue under the skin. These cords can limit or prevent the fingers and thumb from straightening or from spreading apart.

In a Dupuytren’s contracture, nodules under the skin thicken, forming cords of tissue that pull the involved fingers inward towards the palm.

Contractures. As the tissue under the skin tightens, one or more of your fingers may be pulled toward your palm, and you may have trouble spreading them apart. The ring and little (pinky) fingers are most commonly affected, but any or all of the fingers and thumb can be involved.

When a finger is involved in a Dupuytren’s contracture:

• The metacarpophalangeal (MCP) joint is the most common joint to be affected. This is the joint where the finger meets the hand (knuckle).
• The next most common joint to be affected is the proximal interphalangeal (PIP) joint. This is the next joint in the middle of the finger after the MCP joint. Contractures of the PIP joint are harder to treat and less likely to completely recover after treatment than contractures of the MCP joint.
• The distal interphalangeal (DIP) joint, the last joint of the fingers (closest to the fingernail). is less likely than the PIP and MCP joints to be affected by Dupuytren’s disease.

Dupuytren’s disease can be progressive, meaning it gets worse over time. As the bend in your finger increases, it may be hard to straighten it fully. It may be difficult to grasp large objects, put your hand in your pocket, or perform other simple activities.

Some patients with Dupuytren’s disease may develop thickened tissue on the feet (Ledderhose disease) or penis (Peyronie’s disease). Symptoms do not typically occur anywhere else on the body.

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Your doctor will likely talk with you about your general health and medical history and ask about your symptoms. Because Dupuytren’s can run in families, your doctor may ask if you are aware of any relatives who have the disease.

Your doctor will then examine your fingers and hand. During the exam, they will likely:

• Record the location of nodules and cords on your palm
• Measure the range of motion of your fingers and thumb
• Test the feeling in your fingers and thumb
• In some cases, document the appearance of your hand with clinical photographs

During the exam, your doctor will measure the contracture in your finger, and record the location of the cords and nodules.

These measurements may be compared with other measurements taken throughout your treatment to determine whether the condition is progressing (getting worse) over time.

Currently, there is no cure for Dupuytren’s; however, the condition is not life- or limb-threatening. Dupuytren’s is not a malignancy (cancer) and does not spread to the heart, lungs, brain, etc.

Although its effects vary from patient to patient, Dupuytren’s usually progresses (gets worse) very slowly and may not become troublesome for many years. In fact, for some patients, the condition may never progress beyond developing lumps in the palm.

If the condition does progress, your doctor may first recommend nonsurgical treatment to help slow the disease.

Nonsurgical Treatment

Steroid injection. Corticosteroids are powerful anti-inflammatory medications that can be injected into a painful nodule to help reduce symptoms. The effectiveness of a steroid injection varies from patient to patient. While corticosteroids may help with symptoms, they are not likely to keep the disease from getting worse; therefore, they are a treatment, not a cure.

Splinting. While many patients ask about splints to prevent progression of Dupuytren’s, splinting is not known to prevent the progression of a finger contracture. Forceful stretching of the contracted finger is not helpful and, in fact, could cause an injury to the finger or hand.

Splinting may be used after surgery for Dupuytren’s contracture to protect the surgical site; however, it is not known if wearing a splint reduces the risk of recurrent (repeated) contracture or tightening of the healing wound.

Collagenase injection. The collagen (a type of protein) that makes up a Dupuytren’s cord is different than the collagen that makes up the other structures of the hand (e.g. tendons, nerves, blood vessels, and bones). An injectable medication has been developed to take advantage of these differences.

Collagenases are enzymes that break down collagen, and a targeted collagenase was created to specifically break down the collagen in Dupuytren’s cords without damaging the collagen of the other important structures of the hand. When injected properly into a Dupuytren’s cord, this collagenase can help rupture the cord, allowing for improved motion of the digit (finger or thumb). While the collagenase does not completely remove the cord, symptoms can still be improved following treatment.

Collagenase treatment of Dupuytren’s is a two-step process.

• First, the cord is injected with the medication. The medication is then allowed to work for 2 to 3 days.
• Then, at a separate visit, the finger is manipulated (moved in a controlled way by the doctor) until the cord ruptures.

While this is a good non-operative alternative to surgery, it should be noted that recurrence (return) of the disease is higher with this treatment than with surgery. Collagenase injection typically results in less pain and swelling than major surgery and may be a good option in patients with multiple medical issues who are not good candidates for surgery.

Although rare, the injection may cause an allergic reaction or flexor tendon rupture. Other potential complications are the same as those for surgery: infection, nerve or blood vessel injury, pain, and stiffness.

Needle aponeurotomy. Needle aponeurotomy can often be performed in the office with local anesthesia (injection of a numbing medication).

In this procedure, the Dupuytren’s cord is broken up with a small needle that is placed into the cord and then moved precisely until it cuts completely through the cord. While this doesn’t remove the cord, putting a break in the cord allows for improved finger motion. As with collagenase injection, recurrence (return) of the disease may be more likely with this treatment than with surgery.

The complications of needle aponeurotomy are rare but may include infection, nerve or blood vessel injury, pain, and stiffness.

Surgical Treatment

If the contracture interferes with hand function, your doctor may recommend surgical treatment. The goal of surgery is to reduce the contracture and improve motion in the affected fingers.

There is no known cure for Dupuytren’s contracture; however, surgery is intended to “set back the clock” by reducing the restricting (limiting) effect of the cords by either disrupting or removing them. Unfortunately, the healing tissues will form with the same potential to develop cords in the future — but the gains in hand function can still be significant.

The surgical procedures most commonly performed for Dupuytren’s contracture are:

• Fasciotomy
• Partial palmar fasciectomy

Your doctor will talk with you about which procedure is best in your case.

Fasciotomy. In this procedure, your doctor will make an incision in your palm, then divide the thickened cord(s) of tissue. Although the cord itself is not removed, dividing it helps to decrease the contracture and increase movement of the affected finger.

Fasciotomy is typically performed using a local anesthetic that numbs just your hand without putting you to sleep. After the procedure, your wound is often left open and allowed to heal gradually. You will typically have to wear a splint during your recovery.

Because the diseased tissue is not removed, recurrence (return) of the contracture may be more likely for this procedure than for partial palmar fasciectomy (described below).

(Left) Clinical photo shows the contracture of a patient’s little finger before fasciotomy. (Right) After the procedure, the patient is able to straighten his finger. The wound is left open to heal.

Partial palmar fasciectomy. In this procedure, your doctor will make an incision, then remove as much of the abnormal tissue and cord(s) as possible to straighten your finger(s). Several types of incisions can be used in a fasciectomy; however, “zig-zag” incisions are typically used. These incisions allow the skin to heal without causing more contracture.

In some cases, your wound will be left open to heal gradually on its own after fasciectomy. In other cases, a skin graft will be needed to help the wound heal. For the skin graft, your doctor will typically take healthy skin from another area of your body and use it to seal the wound. You may have to wear a splint during your recovery.

Partial palmar fasciectomy is a more extensive (bigger) procedure than fasciotomy. It generally means more wound care and physical therapy, a longer healing time, and greater patient effort during recovery. However, the benefit is removal of as much of the diseased tissue as possible, which can help prevent recurrence (return) of the disease.

Of note, in some very severe cases, your doctor may recommend applying a Digit Widget® to the affected finger before surgery. This device, which is typically applied in an operating room, gradually stretches out the finger and cord(s) over about 6 weeks, which can make the Dupuytren’s surgery easier to perform, safer, and, potentially, more effective. The device can be removed at the time of the partial palmar fasciectomy.

(Left) Clinical photo shows the zig-zag incisions commonly used in a subtotal palmar fasciectomy. (Right) Following wound healing, this patient has good finger extension and improved function in his hand.

Complications. As with any surgery, there are risks associated with surgery for Dupuytren’s contracture. The likelihood of complications increases with the following:

• The severity of the contracture
• The number of contractures addressed in a single procedure
• The presence of any other medical conditions

Your doctor will discuss each of the risks with you and will take specific steps to help avoid potential complications. Possible risks and complications of surgery for Dupuytren’s include:

• Pain
• Scarring
• Injury to nerves and/or blood vessels
• Wound infection
• Stiffness
• Loss of sensation; temporary loss of sensation may result from stretching nerves that have been contracted for a long time
• Loss of viability (ability to live) of a finger/loss of a finger (rare)

You may need to wear a splint to help protect your hand after surgery.

Recovery. Severe problems are not common after surgery, but you should expect some pain, swelling, and stiffness. Although the goal of surgery is to improve the ability to straighten the digits, sometimes patients can lose the ability to bend the involved digits due to stiffness. Elevating your hand above your heart and gently moving your fingers will help decrease swelling and should improve stiffness.

Physical therapy can help improve strength and function in your fingers and hand, reduce swelling, and aid in wound care. Often, a hand therapist will make a splint for you to wear during recovery.

Outcomes. Most patients have improved movement in their fingers after surgery. However, because the condition is not “cured” with surgery, about 20% of patients will experience a meaningful degree of contracture recurrence (the contracture comes back). Additional surgery may be required for some patients.

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In general, treatment of Dupuytren’s disease can be quite successful. While many patients do not have 100% return to pre-disease motion of their digits, symptoms are often greatly improved following treatment, allowing for return to good hand function.

A very important note is that as Dupuytren’s progresses (worsens), it becomes harder to treat and outcomes worsen. Therefore, if you have Dupuytren’s or are concerned you may have Dupuytren’s, it is a good idea to see a hand surgeon sooner rather than later to ensure the best possible outcome.

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Trigger finger causes and treatment

Speaking of Health

Friday, November 18, 2022

Topics in this Post

• Orthopedic Health

Your hands are mechanical marvels, with pulleys — in the form of tendons — flexing and extending to open and close your fist, and straighten and bend your fingers. Each tendon is wrapped in a sheath that holds it in place.

The tendon sometimes can become irritated and swell, preventing it from sliding smoothly under the sheath. When that happens, your finger or thumb can get stuck in a bent or straight position in a condition called trigger finger.

Who can get trigger finger?

Typically, people 45 and older and those with diabetes or rheumatoid arthritis may be predisposed to trigger finger. It’s rare in children. Usually, the tendon sheath becomes irritated due to overwork or injury, so people who do repetitive movements, heavy squeezing or lifting in their work can be prone to the condition. It can happen at any time and is more common than people realize.

How is it treated?

If you’re experiencing mild symptoms, such as a small, tender lump at the base of a finger or your thumb on the palm side of your hand but can straighten or bend your finger without it locking, take an over-the-counter anti-inflammatory medication, such as ibuprofen, every day for two weeks. If your finger or thumb is locked, you may be able to use gentle pressure to force it straight or bent.

If your finger or thumb is locked, you’re not able to force it straight or bent, and you’re feeling catching or popping, the next level of treatment is a steroid injection to calm the irritation and swelling. Performed in the clinic, the injection is done in the palm of your hand. A cold spray is used to numb the area.

One injection may alleviate the problem, but it may recur. If so, another injection may be done after three months.

A less common, nonsurgical treatment is splinting. At night, you wear a splint to keep your affected finger or thumb straight.

Is surgery an option?

When over-the-counter medications and steroid injections aren’t effective, you may need surgery, which is a quick, same-day procedure. A small incision is made in your palm, usually along the crease so a scar will be less noticeable. The surgeon probes under the skin to loosen the adhesion.

You can go home the same day, although for 10–14 days, you’ll have limited use of your surgical hand while it heals. You’ll be able to dress, drive, eat and do other light activities, making sure you don’t lift anything heavier than 15 pounds.

After about 10 days to two weeks, you’ll return to the clinic where the dressing and stitches will be removed. Most people can go back to work without any restrictions and seldom need follow-up physical therapy.

Can trigger finger be prevented?

Awareness is the first line of prevention. If you notice a small, tender lump at the base of your thumb or finger or experience catching or popping, you may want to consult with an orthopedic health care professional.

Sara Snyder is a nurse practitioner in Orthopedics in Fairmont, Minnesota.

Topics in this Post

• Orthopedic Health

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How to choose the right running shoe size

When it comes to running shoes, size matters. It depends on how responsibly you approach this issue whether you will suffer from corns or have fun and improve your own results. We deal with ASICS experts how to make the right choice and not make a fatal mistake.

1. Don’t look only at the size

Buying shoes only by looking at the size labels is not very correct. When you run, your foot “falls out” slightly forward due to inertia and your toes rest against the toe of the sneaker more than usual. Shoes that are too tight are a direct path to calluses and pain in the big toe, while shoes that are too loose allow the foot to dangle, leading to ankle and knee injuries, making it easier to twist the foot. It is important to find a balance so that there is a small amount of room for the thumb, but at the same time, the shoes fit snugly in fullness.

2. Buy generously

There should be about the width of your thumb between the tip of your big toe and the tip of your shoe. The fingers should move freely inside the shoe – this, by the way, is the recommendation of the American Academy of Orthopedic Surgeons. Your running shoes should be about half a size larger than your normal size.

3. In the middle of the foot, the shoe should fit snugly.

The shoe should be like a glove in the part where your foot has an arch. At the same time, it should be like this initially, even if you do not tighten the laces as much as possible. If your sneakers are comfortable but not perfect, it might be worth picking them up, but trying a different lacing method can often help improve the fit.

4. Pay attention to the heel

The heel of a running shoe that is loose or too tight can be a “killer” on a run: no one liked calluses. When trying on, pull on your sneakers and try to walk: if the heel dangles, choose a smaller size.

5. Shoes should fit right from the start

You should be comfortable from the moment you put them on. If you think – “somehow I break it”, immediately refuse to buy these sneakers.

6. Take your socks with you

Try on your running shoes with the socks you usually wear: some, when combined with an unusual new pair, may slip, others may rub. And it is better to know about it before buying. You will never guess what kind of socks you will be offered in the store: perhaps they can hide the flaws of sneakers. For example, high socks – the fact that sneakers are the wrong height and rub your bone. If you wear special orthopedic insoles, take them with you to try them on: they can seriously affect what size you need.

7. Simulate your run

If possible, try running your shoes on the surface you normally run on to see how well they support or cushion your foot. Good running shoes vary in the type of surface they are designed for, as well as in distance, pronation, and running style – well, you should first know these indicators, and then go to the store.

8. Learn all about your pronation

As much as we would like to find the perfect pair of colors and comfort, we should not discount the anatomical features of the foot. Therefore, before buying, it is worth knowing your pronation and choosing shoes with appropriate support: it is better to buy something that looks “scary” than to get injured in “beautiful” sneakers later. Indirectly, pronation and supination can be judged by the imprint of the arch of a wet foot on paper: if the isthmus between the toe and heel is more than half the distance from the outer to the inner edge of the foot, then most likely you will need sneakers with an arch support and even an orthopedic consultation.

9. Measure the foot

The foot tends to change: with age, weight gain or loss, pregnancy or injury. It is not worth hoping that one day you can remember the cherished figures of the size and not remember the need to try on forever. Always be sure to try on new sneakers: the size may differ not only for different brands, but even for different models within the same brand – some sit more tightly in the toe, some, on the contrary, are very “voluminous”.

10. Go shopping in the evening

When you run, the blood rushes to your legs, and therefore they swell. It may not be noticeable during a typical fitting in the store, but it’s worth remembering: it’s good if you come to the store after a hard day with swollen and tired legs – this will give you an idea of ​​\u200b\u200bwhat they can be like after a run.

11. Don’t get hung up on shoes only for your gender

Most often, women ask to bring sneakers from the women’s line, and men – from the men’s line (which is quite logical).