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Footwear changes can be one of the most effective ways of reducing pain in our patients.
Often our patients are unaware of how a well fitting shoe should feel or what features of a shoe they should be looking for. Here’s a brief guide.
A well constructed shoe (see the image to the right) should have the following 5 features:
- A stiff heel counter – this will give the shoe structure.
- A well made upper – some shoes have uppers that are very flimsy which again can mean the shoe is not offering enough support from side to side.
- A well constructed sole – this doesn’t always mean very cushioned as it depends on what the shoe is for. Generally shoes with cushioning are more comfortable but the sole should be hard wearing. If the outer sole is visibly wearing after a short period of time it means the material they have used is not good enough quality for the demands you need,
- A deep enough toe box – the toe box of a shoe can cause trouble if it pushes on the joints or ‘knuckles’ of the toes. We often see corns and hard skin build up on feet where the shoes have been too shallow. Ideally you shoudn’t feel the top of the toe box when you are standing.
- A fastening – To keep the shoe in place you should have a fastening, this can be a zip, lace, buckle or velcro. Slip on shoes can be fine if the material encloses the whole foot. If a slip on shoe is very open, they can cause trouble and if they have to be very tight around the toes in order for them to stay on your feet, this may put pressure on the toes and nails.
These are our suggestions on what to look for in a good shoe. This is a contentious topic and many people have their own views on footwear. The best advice we can offer is make sure you are comfortable. If your feet hurt in a pair of shoes, it is very likely to be the shoes that are causing the pain and you should change them.
Bare foot or minimalist shoes will have many of these features and if they are well constructed will follow most of the points above. These tend to have a lower heel and slightly less rigidity to the uppers however, if they are well made will have good quality outer soles.
Activity specific footwear.
You really should have a pair of shoes suited to the activity you wish to carry out.
It is very hard to summarise the best footwear for every person for every activity, so if you want specific advice for you, it is best to speak with a Podiatrist. In general, you will probably be able to find good advice from other people who do the same activities as you do.
You can buy boots or shoes. The boots will give more ankle support but will generally be heavier depending on the material they are made from.
Gortex and boots with a material upper will be the lightest brands. Leather is a brilliant material for walking boots and shoes as it lasts well, but you do have to maintain it. If you’re not the sort of person who looks after their shoes, then maybe gortex is for you.
Shoes and boots made from materials like gortex will be cooler to wear, so if you’re looking for a winter boot then a leather boot, or a material boot with extra lining might be better.
Also make sure you can use the fastenings.
Some boots have speed laces (a pulley type of lace), more and more will have a BoaⓇ fastening rather than traditional laces. These can be fab for ease of use but make sure you know how to use them and you are able to fasten your feet in properly – this is really important. In many shoes you can change / adapt the laces quite easily.
When you put on a pair of walking boots and shoes you should follow these rules:
- Wear suitable socks. You should try to mimic the conditions you will be walking in so take thick socks for example if you are going to walk in the winter.
- Shop towards the end of the day. Your feet will swell slightly during the day so if you shop in the afternoon, and they are a good fit, your shoes shouldn’t ever be too tight. You can always add a pair of socks if they feel a little too loose. .
- Your walking shoes /boots should feel like they were made for you! If there’s something annoying abou the heel or he tongue, then it’s not right for your foot shape. Even if you love the design – you will regret it after a long walk and blisters if you buy the wrong shoes.
- Even if you think you know what shoe size you are, try on a half size up and down to make aure you have the right size. Brands do vary in their shape so you might find a half size up is better.
This is a very inidividual choice. It is really important right from the outset to say that although there is loads of research going on at the moment with the event of the new running shoe technology from the big sports brands Nike, Hoka etc but currently there is no solid evidence base to prove that we can issue a running shoe prescription to prevent injury. We have loads of information we can apply to each individual case but assigning a runner to a shoe “type” is still out for discussion.
A running shoe has a few features you should know about.
The outer sole is the rubber out sole with the grip.
The midsole is the central piece of material usually an EVA foam
The upper is the material that makes up the sides of the shoe
The “heel drop” is the difference between the toe and the heel – so if the toe section of the shoe is 4mm from the ground and the heel is 10mm from the ground, the heel drop is 6mm. Different runners will prefer a different heel drop.
- Also referred to as barefoot shoes are often a flexible shoe with a slim/thin sole made from a hard wearing rubber compound. These shoes usually have a low heel drop (around 4mm – but can vary). They can have cushioning but are always a small heel drop.
- These shoes are designed for runners who don’t show “excessive pronation” when they are running. From a podiatrist’s perspective the term “over pronation “ is fast becoming extinct however for the purposes of the general population it means a foot type that needs little help with stability. They tend to work well in runners with a midfoot or forefoot strike.
- A stability shoe is designed for those who lack the stability in the foot and runners who tend to heel strike. They have a firmer piece of EVA in the inside (medial) edge of the shoe. These also tend to have around a 10 mm heel drop
- These shoes are very cushioned and again are generally chosen by runners who heel strike. These have a high heel drop like motion control shoes.
As we are sure many of you know, many brands are now using carbon plates in the shoe to add a stiffness and a spring to improve performance which is a new addition. These will become the new normal in racing shoes.
We tend to ask people to buy running shoes based on comfort with the reasoning that if you can run comfortably then you are most likely to run naturally and be less prone to an injury.
The running shoe you wear should feel like it was made for you. If you feel any rubbing or irritation anywhere you should not buy it – even if it is the new trend or everyone else is wearing it. Also be aware that sometimes brands do alter their lines so if a brand and model of shoe is your go-to always check if they have remodelled or altered it in any way.
Heel rubbing in running shoes.
There is a trick to help to reduce heel rubbing in a shoe. You will see that there is often an extra hole at the top of the laces. This is for “ace locking”. Essentially you thread the lace through this hole once more which gives extra friction to the laces so the shoe doesn’t loosen while you wear it. this video shows you how to lace lock.It helps to hold you in the shoe more firmly and reduce heel slippage.
Football, Rugby and other studded footwear
- Studded footwear generally is very unforgiving.
The pattern of studs on the underside of the shoe can cause a pressure point on the foot – so if you have a painful area on the foot (under a metatarsal head) then you might need to look for a stud pattern that avoids your pain.
Often players in the summer months or on artificial grass look for moulded boots. These are generally sports and position specific, for example a forward in rugby will want longer studs to ensure proper traction during a scrumage.
- There are some brands that are cut narrow and often in the case of football (soccer) the players like to feel the touch of the ball which is really important. We try to recommend that the player wears a boot with enough space so not to squash their toes. Asics do a brilliantly fitting shoe designed for Aussie Rules Football (the Gel lethal ultimate) which has a useful depth to it and a removable liner which is also really useful for putting foot orthoses in. It has a studded and a moulded version which can be really useful for us a podiatrists.
- Tennis shoes are designed to support the foot in a side to side direction as you move across the court.
- They generally have a rigid upper and are very grippy. They tend to be less cushioned also.
- Of course there are also shoes designed for a clay court, hard court, indoor and grass.
- Like Tennis shoes, Squash shoes need to have lateral support (for side to side movement) . The main difference is in the outer sole. They tend to be made using a gum rubber and not a black rubber to prevent marking on the court and to maintain grip.
- Gym footwear hugely varies depending on the activities you are doing.
- If you are on a running machine then you should be in a running shoe that is suitable for you. You can wear a more general athletic shoe if you are lifting weights or on the bikes.
Work Safety Footwear
- In the UK safety footwear should be CE mark stamped.
- Your employer (if required) should also give you the footwear suitable to your role. This doesn’t always mean steel toecaps, it could be an anti-static requirement, anti-slip soles, or protection from chemical spills for example.
- Like all footwear tehy should be comfortable from as soon as you put them on and you shouldn’t feel that you have to “break them in”.
Heels and Court shoes
- Many workers wish to wear a heeled shoe to work for many reasons.
- Our advice would be to wear a block heel rather than a stiletto as they are more stable and spread the forces throught the foot more effectively. Also a outer sole with a grip is useful as many heeled shoes allow you to slip easily especially on smooth floors.
- Also wearing a heeled shoe with a platform under the toes and a small heel decreases the angle the foot sits at, but still gives the height that you want.
- If you can alter the shoe you wear, vary the heel heights and if you walk to work, wear trainers and then change into “office shoes” once you arrive.
Leather office shoes
- These can be really sensible shoes. As long as the toebox isn’t too pointed you can be very comfy in these all day.
- Opting for a rubber sole if possible and nothing too flat i.e. have a small heel then should have happy feet.
The bottom line for all footwear is always “Comfort is King!”
Please make sure you buy the most comfortable shoes you can find for the occasion or sport you need and you won’t go far wrong.