Dr Maina sees a fair number of people who present to her practice complaining of foot problems.
On an average day, your feet can carry up to three times your body weight each step, so, when it strikes, foot pain is virtually impossible to ignore.
While there are a wide range of diseases and injuries that can negatively impact the structures in the foot, most foot pain in healthy individuals is caused by wearing shoes that don’t fit well.
These shoes are either too tight, of an inappropriate design (too little support, too rigid etc) or the wrong shape for your feet.
Prolonged pressure due to incorrect shoes alters how one walks and runs. This causes the rest of the body to compensate, resulting in injuries like back pain, achilles tendon injuries, ‘shin splints’ among other conditions.
Shoes that are too tight or of an inappropriate design can cause foot pain.
Finding the right fit
As one gets older our shoe size gradually increases due to the cumulative weight over time that our feet carry. Poorly fitting shoes can also increase the risk of falls and other injuries.
Aside from aging, conditions such as traumatic injuries, pregnancy, progressive general/orthopaedic diseases among other changes also cause ones shoe size to change over time.
Most people’s left and right foot is not the same size. For this reason, it is important to measure the size of both feet each time one goes to buy shoes. Always shop for the larger foot.
The right shoe should fit properly from the word go. Trust your judgement the first time you put the shoe on. Your feet shouldn’t be forced into shoes and shoes do not need to be ‘broken in’.
Avoid shoes with seams that irritate or apply pressure on your foot.
The right fit may come in a different size and cut. You don't have to stick to your old shoe size.
You should not pay strict attention to a specific shoe size because different manufacturers create shoes of varying cuts despite them being them sharing a numbered size.
Slightly over 10 millimeters should be left between the tip of the shoe and the longest toe to account for the flexibility of the toebox (the front part of the shoe) when walking. A short shoe can cause nailbed injuries and painful lifting of the nail which can require surgical intervention to treat.
The ‘correct shoe’ is one that fits both the width and length of your feet. Consideration should also be made of the fit and support at the heel part of the shoe.
If you have custom orthotics, do remember to take them with you for your shoe fitting as certain shoes may not be compatible or comfortable with your fitted orthotic.
High heels should be worn over brief durations due to the abnormal pressures created in the foot and the resultant altered posture.
High heels
High heels should be avoided where possible. A high heel is defined as a shoe in which the wearer’s heel sits greater than 2cm higher than their toes.
If high heels must be worn, platforms or wedges are a safer bet than stilettoes, and their use should be limited to brief durations on special occasions.
High heels force crowding of toes in a narrow, pointed space causing pain and increasing the risk of bunions.
A raised heel also forces increased pressure under the ball of the foot.
A raised center of gravity also changes ones posture and ones walking pattern, increasing the risk of falls and serious injury.
It is important to take your time when shoe shopping to avoid costly and painful mistakes.
What to remember when shoe shopping
If you have a history of foot pain or have specific health or foot conditions, it is a good idea to first seek a podiatrists’ advice for the best footwear to match your unique needs.
When shopping, seek a store with trained salespeople who can professionally measure your feet and assess how you walk.
Some specialist stores in South Africa even offer on-site 3D foot mapping and a digital gait analysis that can help gauge whether the arch of your foot is pronating (rolling inward, collapsing toward the midline and flattening the arch) or is supinating (a high arched foot that rolls toward the outside of the ankle).
A good quality shoe should have a fairly rigid heel, should be flexible in the toebox but slightly more rigid at the ball and arch of the foot. A well built shoe should not buckle in the middle when twisted in one’s hands.
Shoe shopping should be reserved for afternoons, as this is when one’s feet are at their widest after a morning of walking and/or sitting. Feet are also bigger in warmer weather.
Various shoe retailers in SA supply shoes in varying widths to accommodate a wider range of foot shapes.
People with flat feet generally require wider shoes. They also need shoes with a firm sole and heel. This limits overpronation. They should avoid shoes with a pointed, narrow or small toe box to allow the toes to spread out.
Beware of buying a longer shoe to get the correct width, as this can create more problems than you solve.
Most people are unaware that there are several retailers in South Africa who supply varying shoe widths within the same shoe size. Seeking specialist advice can avoid unnecessary frustration and expense for those with specific shoe requirements.
Remember to take your regular socks and orthotics with you when buying new shoes.
How to try on new shoes
Always take a pair of socks or tights – similar to that which you will be wearing regularly in the shoe – with you to the store.
With your socks on, try both shoes on.
One should be able to wiggle the toes without the toebox feeling too snug around the forefoot.
Stand, walk, jog and try the shoes on different surfaces (tiles, carpet, treadmill, etc) in the store.
Children outgrow their shoes very quickly. It is important to keep checking their shoe for wear and fit.
Children
Children should get to try their shoes out in person at the store because their shoe and sock sizes change every few months. Their feet should always be remeasured before getting another pair of shoes.
The same shoe size may fit differently from brand to brand, so they should try the shoes before their parents buy.
Hand-me-downs from siblings can be problematic. Not only would these used shoes fit differently from person to person, but they can also be a quick way to share and spread fungal foot and toenail infections.
It is important to keep checking children’s shoe fit and sole wear to see if they are walking without problems.
Athletes need to choose the right running shoe to protect and support their feet.
Sports specific shoewear
In general, sport-specific shoes should be replaced every year.
Running shoes, on the other hand, should be replaced after about 1000km km (or six months) of running. When replacing shoes, it is important to check the wear pattern on the shoe to help direct the type of support your next shoe should have.
Running:
Runners commonly suffer from plantar fasciitis, stress fractures, shin splints, bunions and Morton’s neuromas.
Running shoes should provide adequate arch support.
- Runners with flat feet or low arches should get shoes that provide both stability and motion control while giving adequate arch support (neutralizing or antipronatory shoes).
- Runners with normal arches can wear a wide range of shoes but are not immune to lower limb problems. They should seek shoes with equal amounts stability and cushioning.
- Runners with high arches should wear shoes that offer more flexibility and ample cushioning at the midsole to provide limit the injuries caused by repeated impact.
Running shoes should have a gap of approximately a thumb’s width from the longest toe to the front of the shoe.
Athletes should avoid training in shoes from other sports when running, as these shoes may not provide adequate stability and protection from injury.
Basketball shoes provide ankle support during quick changes in direction when playing.
Basketball, tennis and volleyball
Basketball, tennis and volleyball players commonly suffer from sprains, stress fractures and tendinitis.
Baskeball shoes provide ankle support during quick changes in direction.
Volleyball shoes are light, have a responsive sole and reduced midsole support.
Tennis shoes have a thick, stiff sole supporting the foot on impact with the ground.
Soccer players may suffer from a range of lower limb injuries.
Soccer
Soccer players commonly suffer from turf toe, Sever’s disease, ingrown toenails and ankle sprains
Their shoes should have moulded rubber cleats (not screw on studs) specific to the playing surface (turf, hard, soft, etc)
The sole of the soccer boot should provide proper arch support.
While flip flops and sandals may not provide enough support for long walks, they provide essential protection around pools and other shared public spaces from various foot infections.
Casual wear
Flip flips (slops)/sandals
Flip flops or sandals are poorly suited to wearing over long distances. They also provide little support and protection when participating in sports/outdoor activities.
Around public pools, at the beach, in hotel rooms and locker rooms, however, sandals are protective in reducing one’s exposure to communicable foot infections such as athletes’ foot (fungal infection) and plantar warts (viral infection).
High quality soft leather flip flops/sandals reduce the risk of blisters and irritation.
Well-made sandals should not only bend at the ball of the foot and never in the middle.
A well-fitting flip flop/sandal should not allow any part of the foot to hang off the edge of it.
Walking barefoot promotes the natural development of sensory and motor function in children..
What about being barefoot and the ‘barefoot shoe’?
Studies on barefoot walking and shoes with limited cushioning have provided limited conclusive data, but point toward the fact that the more cushioned the shoe, the less the sensory feedback the foot gets when walking.
Certain types of cushioning also have an adverse effect on joints – they increase the pressure transmitted across certain joints.
Overall, barefoot walking is encouraged in children to promote the natural development of their feet, musculature and posture.
One tip to avoid ill-fitting shoes is to trace an outline of one’s feet on a piece of thick paper. Taking that shopping allows one to eliminate from one’s options any shoes narrower than the drawn outline.
Wearing poorly fitting shoes not only causes foot pain, but can contribute to falls and serious injury.
Conclusion
Falls are the leading cause of non-fatal injuries worldwide.
Well fitting shoes can reduce the risk of serious injury by improving balance and mobility. The correct shoe will also reduce the risk of debilitating foot pain and foot conditions.
Women are disproportionately affected the most by foot pain because they generally tend to wear shoes that are too tight, are narrow fitting and have high heels.
Off-the-shelf orthotics are generally are not helpful for individuals with significant foot and ankle conditions. Dr Maina will need to clinically assess how you stand, walk and run. If needed she may then request the relevant x-rays and refer you to an orthotist who may perform a digital mapping of your feet to help make a custom shoe insert.
Please beware of the marketing hype that promotes certain shoes to the public as ‘health’ or ‘orthopaedic’ shoes. This is a worrisome misnomer because mass produced shoes, shipped online or to general retailers are unlikely to perfectly correct the painful muscle or bone condtion affecting every single person's feet.
Custom-made shoes for people with specific medical conditions or unusual foot shapes are available from specialist cobblers and/orthotists.
'Happy feet' are those whose toes are free to wiggle and spread out.
Dr Anne Maina
Specialist Orthopaedic surgeon
MBBCh (Wits), FC Orth (SA), MMed Ortho (Wits) CIME
References:
1. Sissons, C. 11 of the best shoes for flat feet. Medical News Today. Accessed 21st Oct 2023. https://www.medicalnewstoday.com/articles/best-shoes-for-flat-feet#_noHeaderPrefixedContent
2. American Podiatric Medical Association. Buying Children's Footwear. Accessed 21st Oct 2023. https://www.apma.org/Patients/HealthyFeetTips.cfm?ItemNumber=9861
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