Health matters

Improper shoes can cause issues

Conway McLean, DPM, Journal columnist

Foot pain is a funny thing, although those so afflicted aren’t laughing. It’s hard to rest your foot while going about your normal routine. Pain from this appendage can appear in many forms, cloaked in all manner of strange sensations. Many are confused about what constitutes pain, assuming if it’s not sharp and stabbing, it isn’t pain. What sensations qualify? What about pins and needles or a tingling? Many sensations can qualify when they aren’t normal and comfortable.

Shoes are often strongly associated with foot pain and for more reasons than you might think. Poor design is certainly the cause since many shoe shapes don’t approximate the human form well. Many foot types require some extra support to maintain their musculoskeletal alignment, more than an “average” shoe will provide. A small percent of us have a foot type that allows for perfect function, but most do not. Even slightly abnormal foot and leg architecture may produce inappropriate biomechanical function, eventually stressing some part of the body, over the many steps taken and years lived, leading to altered function, and finally pain.

Some estimates claim three out of four people have a problematic foot architecture, one which has a high likelihood of developing a biomechanically induced condition. The variety of these problems would boggle the mind, from knee arthritis to heel pain, low back syndrome to shin splints, these and many others can be traced to foot anatomy and poor biomechanics. This latter term refers to how everything works together, allowing us to stand, walk, and run.

Shoes also vary as well in the level and kind of support and alignment provided to the wearer. But they are important, providing many critical functions. Physical protection is an obvious one, from the perils of the modern world, the glass shards and rusted cans, the cracked sidewalks, even hard doorways. Insulation against the cold and the elements is another benefit of shoes.

The shoe industry is massive, which is reflected in the variety available. Consequently, shoe construction and design also differs greatly. The kind of support in the arch of a shoe is often insufficient or inappropriate for the individual. This is where an added arch support, placed inside a generic shoe, can be helpful. But how much to add, what kind of device to purchase, and what shoe to use it in, these are pertinent questions.

When this kind insert isn’t sufficient, or someone isn’t certain which of the thousands of products out there would be best for them, professional care may be sought. Prescription supports, generally referred to as foot orthotics, made from a cast of each foot, can sometimes be fashioned in such a way as to maintain that vital alignment of the bones, tendons, and ligaments that must work correctly to avoid the many inflammatory, structural, and functional conditions that cause pain.

Shoes can “cause” problems when some deformity has evolved, a typical example being a bunion. This is a bony bump that develops over some years on the inner side of the foot at the base of the big toe, which drifts slowly over towards the adjacent toes (sometimes eventually over). Fitting this foot into a shoe becomes problematic, pressure to the skin and soft tissues over the bone will lead to a variety of pathologic changes.

Many treat a bunion by buying a wider shoe style. When this doesn’t provide relief, the afflicted starts buying larger shoes. Thus, the removal of chronic force from over the bump sometimes resolves the pain from the bunion. Unfortunately, this ill-fitting foot gear doesn’t support the feet, legs, pelvis and spine correctly. Eventually, some structure will become stressed and symptomatic. But the bunion doesn’t hurt.

Because it is a bony deformity, there is no brace, or support able to provide any lasting correction. This requires some type of surgery, of which there are a multitude. Some of them allow immediate weight bearing with minimal post-operative pain. But a big question is when should one have a bunionectomy (a bunion correction operation)? How much pain must one have? Many so afflicted have no pain, but only because they are wearing the wrong size shoe. Should this be considered appropriate treatment? When they wear correctly fitting shoes, there is pain, but they have learned not to.

A discussion of shoes in modern society has to include a passing nod to the intricacies of sizing. Modern culture has a shoe industry with minimal standards and no requirements for accurate measures of fit. Most have experienced this phenomenon, whereby a specific size in one model fits completely differently than another model, this being the case even with the same manufacturer.

On a similar note, what about the discrepancy between the size of people’s feet and what they think they are? Many people experience a lowering of their arch over the years, in essence making the foot longer. (No, your foot doesn’t start growing when you turn 50!) Consequently, many older adults are trying to wear a shoe that is too small, causing some pain but having no idea it is self-induced.

Lest you forget, every second of the day that we are standing, our physical bodies are fighting gravity. It takes energy, balance, strength, and much more. Many things, especially time, can impair these efforts. And nowhere yet has there been a mention of the effects of aging on heart function, blood vessel health, and many general medical issues which act to reduce tissue vitality and our resistance to physical stress.

Shoes can be a beneficial part of this battle, providing protection and support in just the right amounts. But too often, this is not the case, and our shoes cause us harm, whether it’s due to overuse, poor choices, or bad construction. Think about your shoe gear purchases, get informed, and find out what is the best shoe type for you. In case you didn’t know, homo sapiens are bipedal, using only two feet for supporting our bodies. For lasting musculoskeletal health, even into your later years, you need two shoes for those feet…..but just “any” shoes won’t do.

EDITORS NOTE: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.


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