Health Matters

Indoor shoe use: Here’s what to wear

Conway McLean, DPM, Journal columnist

The pandemic has brought many dramatic changes to the lives of the inhabitants of this planet. From the stay-at-home orders to mask use and the controversy over the protection provided by the vaccine, COVID-19 has profoundly affected the everyday existence of every American. Many jobs are now performed remotely, usually on a Zoom tele-meeting, sitting in front of a laptop computer.

There have been some unexpected repercussions from these changes, while others were more predictable. Many Americans have had less socializing time, leading to feelings of isolation. The pandemic certainly hasn’t been good for our mental health, nor our physical well-being since many of us are getting far less activity. What about the consequences of strolling around the house in our pajamas and socks? It is surprising to many how significant they can be.

Many of us kick off our shoes the minute we walk in the door. Feels good, doesn’t it? Let the toes run free and stretch out those aching arch muscles. But in the times of the pandemic, humans are spending more time in the home than ever before. That means more activities are performed in the home environment than ever. And too often, this means shoeless!

But I have shocking news: the laws of gravity apply…….. even in the home! For many, weight bearing (standing and walking for most of us) is stressful. For a multitude of reasons, problems can develop from being on our feet without the support, protection, and cushioning of a shoe. Who will have pain from going without shoes at home? This is a multifaceted question.

Age is of tremendous importance in this conversation, time affecting the human body as it does. A reduction in blood flow, termed PAD (peripheral arterial disease), is incredibly common and often unrecognized. One of the consequences of this process is impaired healing. Walking without the protection provided by shoes means minor skin trauma has a greater chance of occurring, damage that will heal only slowly if at all in the face of PAD.

The passing years have the effect of thinning and weakening many structures. The special padding under the ball of the foot is important in protecting the bones and tendons found there. When it thins or moves out of position, pain and inflammation can develop. And, when present in combination with a tight Achilles tendon (another common and unrecognized condition), this region of the foot can hurt with every step.

There are complications worse than pain. For those with diabetes, the nerve changes that often go with the disease make it easy to suffer a skin injury and not feel it. In combination with a reduced resistance to microorganisms, infections are too frequent, a diagnosis associated with an increased risk of amputation. The answer is simply to wear some kind of shoe gear in the home, the recommendation of all diabetic experts.

Although some people have good foot and leg mechanics, meaning all the bones and muscles, tendons and ligaments, are all working together properly, at the proper time, in the proper amount, many of us don’t. A common variation is a foot type where the arch rolls down too much when standing and walking. This can lead to various structures experiencing abnormal forces….over time. Again, age is relevant. This kind of foot problem will nearly always be worsened by spending more time barefoot or with socks (which is the same thing). Wearing some kind of supportive shoe gear is the simple solution.

I am not implying that everyone needs to wear shoes in the home. Instead, be smart about it. If you are a 20-something athlete, you have the vitality of youth on your side. Tissues are stronger, tougher, and better able to withstand the rigors of daily life. The support provided by a sports shoe is less necessary. Healing of any skin injury is fast and easy. All these factors change with the years.

Understandably, some people have concerns of introducing germs into the household. Studies have looked at this and, surprisingly, this is not much of an issue. Debris, mud, and all manner of physical contaminants can be carried around on our shoe soles though. The answer obviously is an indoor pair of shoes or slippers.

But are slippers acceptable indoor footwear? There are too many variables, except to say, “for some.” How good is an individual’s skin quality, or their foot structure? Again, the most impactful question is a person’s age? Then, look at the variety of different slippers out there. Some are supportive and protective, both of which are very important characteristics of a shoe. Claims of special cushioning make for good advertising but that’s the least important characteristic of a shoe, despite the commercials proclaiming the virtues of their special foam (which is worthless under the forces of body weight).

The conclusion to this diatribe is simple: think about what’s under your feet. If you are elderly or have bad circulation, protect yourself. Those with diabetes need to learn the important components of good diabetic foot care and the importance of protecting their feet. In these colder climes, protection from frigid floors just feels better. Sure, if you’re young and healthy, it’s a different discussion. But seniors need to get serious about their at-home footwear. Your feet, and your well-being, will thank you.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula. Dr. McLean’s practice, Superior Foot and Ankle Centers, has offices in Marquette and Escanaba, and now the Keweenaw following the recent addition of an office in L’Anse. McLean has lectured internationally, and written dozens of articles on wound care, surgery, and diabetic foot medicine. He is board certified in surgery, wound care, and lower extremity biomechanics.


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