Most people do not know what to look for when buying new shoes.  Do you choose based on color, price, or fit?  Does it matter what sport you are using the shoes for, or is one athletic shoe enough for all your exercise needs?  Really, shoes should be selected based on how they feel, with a balance of support, cushioning, and roominess for your feet.  Special attention should be given to what you will be using the shoes for, whether it is a sport, special event, daily work shoes, or weekend fun.

Patients come to the office daily with shoes that can be rolled into a ball (offering no support), shoes that are too narrow for their feet, shoes with worn out outsoles, and shoes that offer no cushioning.  In many cases, these shoes are part of the reason the patient is in pain.  Poorly constructed shoes can also cause leg, knee, hip, and back pain. Simple adjustments to the type of shoes you buy can make all the difference in eliminating your foot pain.

Parts of the Shoe

Shoes are constructed in a variety of ways and may have as many as twenty-three different parts.  Understanding these different components and why they are important for your foot condition is a big first “step” toward getting the right shoe.  Although all portions of the shoe have important roles, we will discuss the heel counter and toe box in the upper portion of the shoe and the outsole and midsole portions of the sole of the shoe.

The upper portion of the shoe is the “upper” part that attaches to the bottom of the shoe.    This is a critical part of the shoe for proper fit and comfort.  Three parts of the upper that are particularly important for people with foot pain are the heel counter, heel collar, and toe box.

Heel pain is a common complaint of patients, so the heel counter and heel collar are important considerations for their shoes.  The heel counter is the portion of the shoe that covers the heel.  This area should be firm to reduce slippage and provide support. If the heel is already inflamed, a shoe with a flexible heel counter will usually cause worsening of the condition. Just above the heel counter is the heel collar, which offers additional cushioning to the heel. Patients with Achilles tendinitis need a very cushioned heel collar to reduce pain and friction. Frequently people complain of blisters on their heels with new shoes or after running, so a more cushioned heel counter can also reduce blister formation.

The toe box is the front of the shoe where the toes sit in the shoe.  Patients with forefoot pain, including bunions, Tailor’s bunions/bunionettes, hammer toes, and neuromas, need a larger and roomier toe box to reduce pressure and pain. For breathability and comfort, mesh materials in this area work well.   This is surprising to some, but being able to move your toes in the toe box is a good thing!  Research shows that many people are wearing the wrong size of shoes, so it is good to leave half of an inch of room from the end of the longest toe (usually the first or second toe) to the end of the shoe.  Your toes should not be hitting the end of the shoe, and this is particularly important with growing children, who can very quickly grow out of shoes.

The sole portion of the shoe includes two important components, the outsole and midsole.  The outsole is the bottom of the shoe that touches the ground. Rubber is commonly used in athletic shoe outsoles for better traction, and dress shoe outsoles may be made of leather or rubber. Whatever the material, you should check on the wear pattern of your shoe’s outsole, as eventually, the outsole will wear away and lose its effectiveness.  If the outsole is worn out, the shoes need to be replaced to prevent injury and pain.  Another consideration when purchasing shoes is what you will be using the shoes for and making sure the outsole will work for your activity. If you are going dancing or taking a kick boxing class, you may want an outsole that does not offer as much traction as one would need with a walking, running, or hiking.

Just above the outsole, some shoes have a midsole, which is added for cushioning, shock absorption, and protection. Common midsole materials are plastic, rubber, or a combination of both. Athletic shoes often have EVA (ethyl vinyl acetate) or polyurethane components. To prevent over-pronation, which can strain the foot, ankle, and leg, a medial post can be added to the inner part of the midsole, and this can also increase the weight of the shoe.  For some, a combination of stability and cushion is the best choice.

Tips for Shoe Buying

1. Try on shoes later in the day. Some people have swelling of the feet as the day goes on, and this may affect what size and width of shoes you purchase.
2. When trying on the shoes, use socks or hose that you will be wearing with these particular shoes.For example, if you are looking for running shoes, try them on with socks that you will typically wear when running.  If you need shoes for a dressier event, you should try the shoes on with thinner socks or hose.
3. Do not choose based on size alone. Many manufacturers have different shoe sizing protocols.  Thus, a size 9 in one shoe brand may be a size 10 in another brand.
4. Shoe Length. You should be able to wiggle your toes in the new shoe, and one-half inch of space is needed from the end of the longest toe (usually the first or second toe) to the end of the shoe.If the shoe is too short, this can irritate the tips of the toes or cause toenail damage. If one foot is larger than the other, size based on the larger foot to avoid constriction on the larger foot. Also, the size of our feet changes over time, especially with aging or after pregnancy, and you may need a larger sized shoe due to lengthening of the soft tissues of the feet. If you wore a size 6 shoe before pregnancy, your size may increase to a 6.5 or 7 post-pregnancy
5. Toe box. Make sure that the material in the toe box does not compress the toes and cause pain. For example, if you have bunions or hammer toes, you might consider mesh material for your next pair of running shoes to avoid pressure and constriction on the toes.
6. A shoe that is too narrow or too wide can cause rubbing and irritate the foot over time.
7. Try your shoes out in the store. Walk around the store or use an in-store treadmill in the shoes you are trying on to see how they feel.
8. Shoe material.Make sure there are no compressive or irritating materials in the shoes.  For example, tags and seams inside the shoe may rub on your foot, causing blisters and pain later. Choose materials that are softer and more flexible over bony prominences like bunions.

Bring your orthotics along!  If you have orthotics, bring them with you to try on new shoes in order to get the correct size.  Some orthotics can take up more space in the shoe, requiring a larger sized shoe.