Most shoes are not shaped like feet
The best shoes are no shoes. However, if you’re going to wear shoes, you want shoes that don’t interfere with the normal function of the human foot. The majority of shoes (probably 99%) are not shaped like the human foot. They’re actually shaped more like a human hand, which tapers towards the center, with the middle digit being the longest. But there’s a reason the big toe is called the big toe. It’s because that toe is usually the longest and that part of the foot is pretty much square with that side of the foot. There is no gradual taper towards the middle, as the majority of shoes would have you believe. The best shoe will allow the toes to spread out naturally and “do their thing.” The foot has amazing capabilities, but these are usually ignored and the foot is relegated to function more like a unified “hoof” rather than utilize its impressive ability to accommodate, react, and propel in the miracle of human movement.
All “prescription shoes” (grandma shoes, diabetic shoes, etc) have a bad shape and squeeze the toes together. This is especially egregious since these patients will often get pressure sores or other catastrophic problems when the toes are constrained in any way. Shoes with a shape based on the human foot are much healthier than any “prescription shoe” I have ever seen. That is why I always recommend that my patients with sensation problems like diabetic neuropathy or similar issues should be in a shoe with a natural foot shape and a wider toe box.
Why do shoes have heels?
Another common problem with most shoes is the heel. And I’m not talking about “high heels.” Even the seemingly harmless increased height of a typical athletic shoe can have serious negative effects on physiology and mechanics. Why do shoes have heels? I have asked this question of many patients and professionals and the most common response is a pensive look. Another common response is that it is just style and people are used to them. This might be true, but as a medical professional, I have to base my recommendations on science, not style. The elevated heel of most shoes changes the mechanics of the foot in a detrimental way and throws off alignment of the skeleton all the way up to the spine. Please see the excellent illustrations by William Rossi DPM, which show how heels likely contribute to low back pain and malalignment.
In addition, having a tight calf leads to the majority of foot problems I treat daily. Elevated heels on shoes feeds into the tightness of the calf since it allows them to maintain the over-shortened position. Some people feel awkward in shoes with no heel, but the stretch they feel as they transition into a shoe with no difference in height between the toe and heel is actually a good thing. As the calf stretches, the shoe will feel more comfortable and many other foot, ankle, leg, and spine problems sometimes self-correct just by gaining more calf flexibility.
Should shoes have cushioning?
As stated earlier, the best shoes are no shoes. That is, if the person has no foot pathology or abnormalities, and is not at risk of cutting or injuring the foot on something. Someone with a healthy foot can wear shoes with no padding at all and they will be able to recreate the same feeling as walking barefoot, but be more acceptable in modern society.
Other people that have some kind of foot problem or foot pain will benefit from some kind of padding. I often tell patients that my goal is to get them to the point where they can walk comfortably barefoot on a hard floor. However, until then, they will benefit from padding in their shoes. Patient with severe and long-standing problems will be able to relieve much of their symptoms by just putting on a shoe that has a natural foot shape, no heel, and a large amount of cushioning. Hopefully, as they complete their targeted physical therapy or recover from a reconstructive surgery, they will get to the point where they can use a shoe with less and less cushioning until they get to the point where they can walk barefoot on a hard floor.
Good Shoe Features
An ideal shoe has the following characteristics which allow your foot to work like a foot and not interfere with normal physiology:
- A front of the shoe (toe box) with at least ½ inch space in front of your toes.
- No arch support (Studies have shown they don’t work) And, if you have high arches already, they make the problem WORSE.
- No elevated heel (or the least you can tolerate). Completely flat shoes from front to back are best.
- Snug fit at the back of the shoe to keep your foot from sliding around.
Shoe Shopping Tips
- If you’re unsure about fit, wear your new shoes around the house. Then bring them to your doctor to check before using outside.
- Shop late in the day, when your feet will be slightly bigger.
- Each time you buy shoes, have both your feet measured while you are standing. Foot size changes with time.
- Pick shoes to suit their purpose. High heels are okay for an occasional night on the town. But for everyday wear, find a shoe that allows for normal physiological foot function.
- Try on shoes while wearing any inserts specially made for your feet (orthoses). If the shoe has a removable insert, take it out and replace it with any special orthotic so that you don’t pack too much bulk into the shoe and cramp the toe box.
- Try on both the right and left shoes. If your feet are different sizes, pick a pair that fits the larger foot.
- Don’t buy shoes based on shoe size alone. Always try on shoes, as sizes differ from brand to brand and within brands.
- Don’t expect shoes to “break in.” If they don’t fit at the store, don’t buy them.
- Don’t buy a shoe that doesn’t match your foot shape.
If You Have Foot Problems
Some foot problems cause deformities. This can make it hard to find a good fit. Look for shoes made of soft leather to stretch over the deformity. If you have bunions, buy shoes with a wider toe box. To fit hammertoes, look for shoes with a tall toe box. If you have arch problems, you may need inserts. In some cases, you’ll need to have custom footwear or orthoses made for your feet.