To truly understand desperation, all one needs to do is spend a brief period of time with any injured runner. If you need additional proof, hopefully these pictures will suffice. A patient, who I recently saw in consultation for recalcitrant heel pain and presented with a diagnosis of a Haglund’s deformity, brought this pair of shoes to the appointment. Needless to say, he took matters into his own hands and decided to do some shoe modifications by creating a relief in the heel counter. While the integrity of this Brooks trainer is unquestionably compromised, I must say that it’s pretty clean work. The ultimate reason (aside from entertainment) that I’m sharing this picture with my readers, however, is to highlight the importance of screening equipment when working with an injured runner. Had I neglected to request the patient to bring his running shoes to the consultation, I would’ve never known about this equipment modification. Instead, I would have performed the evaluation having missed an integral piece of the puzzle. While the shoe pictured above may afford the patient temporary relief of his heel pain, he would ultimately benefit from going to a running specialty shoe store to be fit for an appropriate shoe. This would most likely involve trialing a number of different shoes on the treadmill until pinpointing the pair, which afforded the greatest comfort while addressing his specific post injury needs. While the patient did present with other impairments that are often responsive to conservative management, selecting appropriate shoes was equally important to foster a successful outcome. It should be mentioned that we also discussed the role of his dress shoes as part of the physical therapy program as they were most likely factoring in to the equation. In closing, always make sure to have runners bring their shoes to the initial consultation because at day’s end, all we have control over are habits, technique, and equipment.