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Health Matters: Shoes make a difference

Conway McLean, DPM, Journal columnist

Ten thousand steps a day. That’s what the average working American takes each day. What protects us, with each and every stride, from the dangers of our environment? Something most of use on a regular basis, one that keeps us going, from place to place, traveling through space. Naturally, as most have surmised, I refer to the noble shoe, our interface between the earth…..and that which is ‘us’.

Footgear is big business, of that there can be no doubt. The global footwear market is a multi-billion dollar industry. The United States has the largest piece of the footwear pie, amounting to nearly 80 billion. The dollars going into the marketing of shoe gear rivals the GNP of a good-sized country. Sports stars are paid crazy dollars for simply wearing one company’s shoes and shoe ads are everywhere.

Why such attention to this most inferior member of our wardrobe? Shoes are important, for many reasons, and serve many vital functions. Some more obvious than others, and several are topics of debate. Do our shoes only protect the foot from this debris-filled environment? Or is there more to it? Might they be an important part of musculoskeletal health for your average citizen and not just your elite athlete? There are studies answering in the affirmative.

When it comes to choosing the right shoes, it’s important to remember that no one shoe brand works for everyone. The features of shoes that you need, such as cushioning and support, vary from person to person depending on the characteristics of your feet. What kind of shoe should you be looking for? Because of the tremendous variety of shoes available, it is helpful to get an assessment by a foot specialist. A physician specializing in this part of the body will be able to evaluate your foot type and level of activity, thereby providing some important recommendations on shoe types and brands.

How high does your heel sit in the shoe relative to the ball of your foot? This is called the heel drop of the shoe. A small percentage of sports shoes are zero heel drop, meaning these two components are at the same level. Older individuals without sufficient Achilles flexibility will experience less knee pain with a more ‘positive’ (aka higher) heel.

An important component of a shoe is the heel counter, that part of the shoe wrapping around the back and sides of the heel. Many foot types benefit from a supportive, stable heel counter. A stability type sports shoe will also resist twisting forces. A pronating foot type, a common condition in which the arch rolls too much, will do better in a shoe with a stiffer midsole. Toe spring refers to the amount of upward curvature at the front of the shoe, which requires less work from the muscles of the feet. This is a positive for some but not others. Again, the kind of information dispensed by a podiatric foot specialist.

A critical aspect of successful footwear is fit, a challenging topic. Shoes vary tremendously in size and shape because of the variations in each shoe ‘last’. This is the form around which a shoe is constructed. These come in different configurations, some narrower, others wider. This last goes a long way to determining what kind of foot will feel and work best in each shoe. The shape of the shoe should match your foot shape.

Some keys to good fit is to find a shoe that feels comfortable right away. Expecting a shoe to “break in” before becoming comfortable is a recipe for problems. It is also beneficial to do your shoe shopping later in the day, or after activity, since this is when our feet are at their largest. A shoe purchased earlier in the day may end up being too tight.

Have a salesman measure your shoe size occasionally since your feet usually become larger and wider as you age. It’s also common for one foot to be slightly bigger than the other so always try on both shoes. And have some time set aside for the shoe buying process, allowing you to walk around with the shoes on. Regardless of what you’re going to pay, check the inside surface of the shoe for prominences or seams.

Because your foot needs to be able to move inside a shoe as you walk, there should be about a thumb’s width, roughly half an inch, past the end of the longest toe. Width needs to be considered as well as length. If the front of your foot is squeezed inside the shoe, you are going to need a wider size or a different model. Another facet of good fit is how well the shoe grips the heel. Those with narrower heels know well this challenge. Your heel should not slip in the shoes when you move

Shoe design and construction are critically important to how well a shoe works, potentially leading to various foot, leg, hip and back problems. A key component of the question of what kind of shoe to buy is one’s foot type. In the broadest sense, foot types (and consequently shoe type) can be broken down into low arched, medium, or higher arched. Also critical is the activities pursued. Those individuals whose primary athletic pursuit is walking will benefit from a lightweight shoe with extra shock absorption in the heel and the ball of the foot. For those with ankle joint problems, a rounded or rocker bottom can assist in better gait.

As a broad generalization, the lower arched foot needs more support via a stiffer sole. A neutral shoe is for a more average foot, while a cushioning shoe is for a higher arched foot type. When it comes to high heels, some can wear them for limited periods of time without significant repercussions. Still, with sufficient use, the stress experienced by various structures will eventually lead to pain.

Selecting the proper shoe can be more challenging for some, especially those with some deformity. Bunions and hammertoes are the most obvious offenders. Those so afflicted tend to go to a wider shoe to relieve their pain. The problem with this approach is the shoe doesn’t fit correctly, and so does not support foot function and gait. Softer materials can be helpful for some. Because of new techniques in corrective surgery, custom orthopedic shoes, although still available, are rarely needed. And diabetic shoes are used by all sorts of people and come in a tremendous variety of sizes.

Astute readers may note the absence of the topic of arch supports and, by extension, foot orthotics. Suffice it to say, these foot braces customize, even individualize, the support and fit of a shoe. Properly prescribed orthotics can correct for all manner of alignment or function problems, certainly more precisely than a generic shoe. Poor mechanics is the root of most cases of heel pain, so more specific support can benefit this and numerous other painful conditions of the foot, leg and spine.

Shoes provide the primary interaction between the body and the ground. Their construction and the support provided can prevent, or produce, all manner of problems. Some have a less obvious cause. We know prolonged periods of standing are associated with an increased risk of musculoskeletal disorders so it stands to reason the right shoes can reduce this. Although often chosen for aesthetic reasons, shoes can improve our health. There has been inadequate research into the optimal design of footwear, yet we know they can make a difference to health and quality of life. Learn about the shoes that are best for you: see a specialist, do some reading, research the internet. Shoes are important to health!

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with a move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments atdrcmclean@outlook.com.

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