Footwear advice
Footwear advice
Why does footwear matter?
You have 26 bones in each of your feet. When you walk, it helps to keep your surrounding muscles and ligaments strong and flexible. In an average lifetime, you can expect your feet to have walked around 100,000 miles, which is the equivalent of five times around the earth.
The footwear that you choose to wear can either help you to maintain a healthy pain-free foot or could cause increased stress and pressure which can aggravate your foot pain. Poorly fitting footwear can also significantly increase your risk of falls or injury.
Tips when buying footwear
- You may not realise it, but over the years your feet naturally change shape and can increase in length and width. That’s why it’s useful to have your feet measured when buying new shoes.
- An expensive shoe is not necessarily a better shoe – there is no guarantee that it will offer you any more support, comfort, or be a better fit than a less expensive shoe.
- Most people tend to have one foot slightly bigger than the other, so always try both shoes on to make sure that they both fit well and are comfortable.
- A correctly fitting shoe will feel comfortable from the start and in the main should not require ‘breaking in’.
Fit and function
When you are purchasing or putting on shoes, it’s important to think about both the fit and function and to ensure that you wear the right shoe for the activity that you are participating in.
The function of the shoe is how the design of the shoe enables or restricts the movement within your foot and ankle. For example, if you are going running you should wear a shoe that has been specifically designed for running, wear a ballet shoe for ballet, a tap shoe for tap dancing and so on.
Party shoes (fashion shoes) were designed for special occasions and not for everyday use. To avoid developing foot problems or aggravating existing problems, save your party shoes for special occasions.
If you wear safety footwear for health and safety reasons at work, it is the duty of your employer to provide these. If you are having problems with the comfort of safety footwear, or they do not have the features your clinician recommended, speak to your employer to see if they can provide alternative footwear; ask your clinician for further advice if they can.
Choosing shoes that are comfortable, protective and supportive
Podiatry colleagues at NHS Lanarkshire have produced this helpful video about why comfortable, protective and supportive footwear is important and how to select shoes:
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A shoe with a good fit will determine how comfortable it is. You can help ensure your shoe is the correct length, width and depth for your foot by:
- ensuring there is a thumb’s width between the end of the shoe and your longest toe
- checking that the shoe is rounded at the front and deep enough to allow your toes room to move
- checking whether the shoe fits comfortably and snugly around your heel – this helps to stabilize the heel as the shoe strikes the ground – you should be able to insert your finger between the back of the shoe and your heel
- wearing a shoe with an adjustable fastening, like laces, straps with buckles, or Velcro to help hold your foot firmly in place and reduce friction
- looking at the sole – ideally it should be thick, shock-absorbing and non-slip with a heel gradient of no more than 1 ½” (4cm)
- wearing a shoe with a curve at the forefoot region, known as a rocker or toe spring, to reduce strain in the tissues in your feet during the propulsive phase of walking
- wearing shoes that are made from natural fibres or breathable synthetic materials that allow moisture to evaporate, with a soft upper that has no hard seams or ridges.
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Poor fitting, old, worn out, slippery or high heeled footwear or shoes that are too large or small, can all cause pain to your feet, mean your feet have to work harder to keep the shoe on, or lead to slips, trips, falls and injury.
When selecting shoes here are some things to consider:
- Very soft flexible shoes will offer no support to your foot and ankle. This can make tired, sore muscles, tendons and ligaments work even harder.
- A shoe with a thin, hard sole, will not provide enough cushion or shock absorption for your foot.
- Shoes made of plastic or rubber are not breathable and will cause your foot to sweat, which can lead to odour, skin irritation and infections.
- Flip flop style shoes and strappy sandals without a heel cup or a strap around the back of your heel mean the shoe is not held on your foot and your toes claw to keep the shoe on.
- A ‘slip-on’ sandle or shoe causes your toes to curl and grip the shoe to keep it on when walking; this can lead to the development of hard skin and corns on the tops and tips of your toes.
- Narrow toed or pointed ‘court shoes‘ squeeze the toes together irritating the delicate skin between and on top of toes causing corns and bunions to form. This can eventually lead to damage of your joints and deformity of your toes. This style of shoe is often found in combination with high heels.
- High heels throw your weight forwards onto the ball of your foot and push your toes into the end of the shoe cramping them and placing strain on your joints and ligaments which can affect the shock absorbency of your foot. Again, hard skin corns and bunions can form eventually lead to damage of your joints and deformity of your toes. If you have worn high heeled shoes for several years, reducing heel height may pull on your calves at first, as over time the muscle at the back of your calf will have shortened, this will soon go as the muscle lengthens again – gentle stretching exercises may help.
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Choose shoes which have:
- a rounded or square toe to allow room for your toes
- a heel no more than 1.5 cm is a comfortable height
- a heel cup to hold the shoe correctly on your foot
- Velcro, elastic strap fastenings or laces mean so you can adjust the width of the front of the shoe
- a cushioned sole to allow for shock absorption and support.
If you spend a lot of time indoors, then your slippers are your most important pair of shoes and the same rules apply.
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Take measurements in the afternoon or evening, when the foot is at its largest size. Wear the socks you usually wear and measure both feet, use the larger of the two when checking footwear size.
To measure your feet:
- Lay a sheet of paper on the floor and ask for assistance if you need it as you’ll need to stand rather than sit to get an accurate measurement for length and width.
- Stand on the piece of paper and draw around the outline of both of your feet on the paper using a pencil.
- Cut the outline of your feet out of the paper.
- Slide the foot shaped piece of paper into the shoe, if the paper curls in length or width this indicates that the shoe may be too small.
Shoe sizes vary from make to make so if you get your feet measured at a shop then use that as only a guide to the shoe size in a different shop.
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- Try new shoes on in the afternoon or early evening, when your feet are at their biggest.
- Wear the socks or tights that will be worn with the shoes.
- Fit the larger foot – you may need an insole for the smaller foot if there is a half-size or more of difference between the feet (such a difference is normal).
- Allow wiggle room for your toes in the front of your shoes. It may seem like a lot of room in the toe but if the shoe is fastened securely on your foot there will be no walking out of the shoe or tripping.
- Check that the shoe is wide enough and not too loose or tight, by feeling across the top of the ball of the foot.
- Stick your little finger inside the shoe along the instep; the shoe should be snug and not too loose around your finger.
- Take a walk to check if the shoe stays on at the heel and there’s not too much room in the toe. Seeing a gap at the back of the shoe, around the ankle, is all right, the shoe holds below there, around the heel.
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To maintain good foot hygiene always change your socks, stockings or tights every day. Ensure that they are the right size for your feet. Socks that are too small are just as harmful as shoes that are too small. They should not have bulky seams which can cause irritation and increase friction. Do not wear socks, stocking or tights with holes in them.
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Footwear which does not fit properly is one of the most common causes of foot wounds in people with diabetes. The development of foot wounds in people with diabetes is serious and is linked to an increased risk of heart attack, stroke, amputations of the foot or leg and early death.
If you are diabetic and have a foot wound, it’s important to get professional help – see our looking after your foot wound if you have diabetes page.
It’s also important to have your annual diabetic foot assessment so our podiatry team can help you to keep your feet healthy.
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Bunions
It is important that you choose footwear that is wide enough to accommodate your bunion. It can also be useful to choose a shoe that has a softer material as the upper. Softer materials can mould easier than hard leathers.
If your shoe is too narrow it will rub on the prominent joint causing the surrounding skin can become red, swollen and in some cases, the skin can blister or become thickened. Sometimes a fluid-filled sac, called a bursa, can develop over the joint. The bursa can also become inflamed and painful.
Stiff, painful big toe (hallux rigidus)
If you have a stiff painful big toe (hallux rigidus), it is important to be aware that your big joint may not bend enough to accommodate being in certain shoes, high heeled shoes, in particular, can increase strain through the big joint.
Some people find it more comfortable to wear a stiffer sole shoe with a curve at the forefoot region. This feature is known as a rocker or toe spring and is beneficial in reducing strain in the tissues in your feet during the propulsive phase of walking.
Hammer or claw toe
It is important that you choose footwear that is deep enough to accommodate any hammer toe or clawing deformities. It can also be useful to choose a shoe that has a softer material as the upper. Softer materials can mould around the toes easier than hard leathers.
If your shoe is not deep enough, it will rub on the prominent joints causing the surrounding skin to become red, swollen and in some cases, the skin can blister or become thickened. Sometimes fluid-filled sacs, called a bursa, can develop over the joint. The bursa can also become inflamed and painful.
Pain in the ball of your foot
If you have pain in the ball of your foot (eg: metatarsalgia, Morton’s neuroma) it may be due to inflammation and swelling in the foot so it is advisable to avoid shoes that have thin, hard soles. These types of shoes will not provide enough cushion or shock absorption for your foot.
Some people benefit from wearing a thicker soled shoe that offers more shock absorption, such as a running style trainer. It is also advisable to avoid shoes that are pointed as they compress your forefoot and aggravate your symptoms. A shoe with a wider toe box can help reduce your symptoms.
Fat pad syndrome
If you have fat pad syndrome with inflammation and swelling in the heel, it is advisable to avoid shoes that have thin, hard soles. These types of shoes will not provide enough cushion or shock absorption for your foot. With the reduced ability of the heel to shock absorb, some people find benefit wearing a thicker soled shoe that offers more shock absorption, such as a running style trainer.
Heel (Hagland’s) bumps
If you have heel (Haglund’s) bumps, avoid shoes with a stiff heel counter as they have less flexibility, which can aggravate the skin overlying heel bumps. This can cause the surrounding skin to become red, swollen and in some cases the skin can blister or become thickened. Sometimes a fluid-filled sac, called a bursa, can develop over the bump. The bursa can also become inflamed and painful. A shoe with a softer heel counter may help this condition.
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You may be prescribed insoles (orthoses) as part of your treatment. These may be in the form of a simple heel pad or a complex device that alters the way your foot functions. In order for the treatment to be successful, it is very important that you wear a shoe that can accommodate the insole.
The shoe should have:
- increased depth at the toe and heel
- an adjustable fastening
- no more than 1 ½” (4cm) heel height, or
- a removable insole that will allow easy accommodation of the prescribed orthoses.