By Carl T. Hasselman, M.D. and Alex J. Kline, M.D.

Over the years shoes have been used for protection, to make a fashion statement, to improve athletic or dramatic performance and as a social status symbol. Styles have changed since the Greek times of sandals to high heel shoes in the 16th Century to constrictive high heel shoes after World War II. Interestingly, in barefoot societies there are few bunions and foot problems; however, in modern societies with constrictive shoe wear, 1 in 6 people will develop problems with their feet. If these facts are known, then why do we continue to wear such shoes and what can we do to improve comfort in our feet?

The most important lesson to remember is this: The mo$t expen$ive $hoe is not nece$$arily the be$t $hoe!!!! Many times you are paying for a name or the advertising of that shoe and not for high quality or what is in your foot’s best interest.

First, we must discuss the anatomy of a shoe by its parts. The top of a shoe (covering the foot) is called the upper and the bottom (the part in contact with the ground) is called the sole. The front of a shoe is called the toebox and the insole is the inside part of the sole that contacts the foot. Each shoe is different in these ways along with color, shape and materials. We usually divide shoes into athletic shoes (for sports and running) and all other shoes for daily wear.

For daily shoes, there are several steps to take to minimize pain associated with shoe wear. First, you want to measure the length and width of your foot. As we age, our feet typically become wider and longer so that the shoe size you were at 20 is probably not the same size at 60. Your foot size determines your shoe size. Once you obtain these measurements, you should write them down and take a ruler to the shoe store with you. The width of the shoe should be no less than ¼ inch of your foot size. For example, if your foot width measured where your toes meet your foot is 3 ½ inches, then the measured width of the shoe should be no less than 3 ¼ inches. As for length, the length of the shoe should be no shorter than the length of your foot measured from the back of your heel to the longest toe on your foot. For example, if your foot length is 12 ½ inches then the shoe should be no less than 12 ½ inches long.

Second, you should find styles that allow for narrow heels but wider toeboxes. Styles such as Easy Spirit, Dansco, Ecco and Merrell have these characteristics. Shoes with laces, buckles, straps or stay ons are better than shoes that do not firmly grab the foot. Shoes without seams in the toebox area, made of softer materials and that have cushioned insoles are better for your feet as well. The heel height of the shoe is not as important as the difference in height between the heel and forefoot area. It is best to keep the difference between the two to 1 inch or less. If you prefer some added height to the heel, make sure that the front of the sole is also built up to keep the difference from front to back to less than 1 inch. Soles with a stiffer rubber material have better shock absorption and decrease arch stress than other types of soles.

For athletic shoes, again I stress: The mo$t expen$ive $hoe is not nece$$arily the be$t $hoe!!!!

The upper portion of the shoe should have characteristics of breathability, durability and lightweight. Leather tops breathe, adapt to the foot, are strong and can be treated to be waterproof. Nylon uppers have the same characteristics but can be loosely woven to increase breathability. Gortex breathes, is lightweight and is waterproof; however, it can be more expensive than the others. The sole should have shock absorption, durability and be lightweight. If you have a high arched foot, you should avoid the sole style referred to as pronators. These soles are thicker in the inside than the outside of the heel. They are designed to turn your heel in slightly when you walk to improve push off strength. However, if you have higher arches in your feet, these shoes will turn your heel in too much and give you pain in the outside ankle area.

The most important aspect of the athletic shoe is its fit. A common misconception is that a shoe may be uncomfortable at first, but will improve as it “breaks in”. This is not true and the shoe should feel good from the moment it is put on. You can use the same measuring methods as for daily shoes, but there are several other methods for athletic shoes. For length, the “thumb test” works well. With the shoe on, you should stand full weight and measure the distance from the longest toe to the tip of the shoe. This distance should be ½ to 1 thumb width. The second test is the “Jam Test”. With the shoe on, you kick the front part of your foot into the floor (as in a sudden stop while running) and be sure that the toes do not uncomfortably jam into the shoe. If they do, the shoe is too short. For width, you can try the “pinch test”. With the shoe on and standing up, you should be able to pinch a small piece of the upper between your thumb and index finger. If you can pinch a lot, the shoe is too wide. If you can’t pinch any material, the shoe is too tight. If you have a tendency to have a narrow heel and a wider forefoot, you may want to go with New Balance or Brooks which do come in widths.

When to change shoes is very dependent on your activity level. Shoes are just like tires on a car. If you use the car a lot, then you will need to change the tires more often. On average, the sole will lose its support between 300 and 500 miles of walking or running. If you change your shoe style, you must also check the fit of the shoe before leaving the store. Each shoe style will have a different fit. Lastly, whatever socks you wear during activity should be worn the day you get your athletic shoes fitted. If you have flatfeet or arthritis in your feet, you will most likely benefit from the cross trainer style of athletic shoe. This style is a little heavier, but gives more arch support during activity. The walking style of athletic shoe also has a stiffer sole to protect the arch, but usually is not as rounded and so it does not reduce stress on the joint as well as a cross trainer.

The most common problem associated with shoes is poor fitting of the shoe. If the above measures are taken when purchasing shoes, then most of the time the shoe will feel good and protect your foot for a long time!