With a normal footstep, the heel hits the ground first, followed by a rolling motion of the foot towards the forefoot and toes. Finally, the footstep is completed by pushing off of the ball area of the foot. During the motion of a normal footstep, the arch absorbs shock as it slightly flattens when the foot rolls toward the toes; the arch then springs back up into position. About half of the arch actually touches the ground, which is considered to be normal pronation.
In reality, many people do not have normal feet with normal pronation that complete normal footsteps. Overpronation and underpronation are two types of irregular footsteps: with overpronation, the foot rolls toward the inside more so than usual; with underpronation, the foot rolls toward the outside more so than usual. Overpronation, which indicates a flat foot and low or collapsed arch, can result in strained arches and pain along the inner area of the knee. Underpronation, which indicates a high arch, can lead to sprained ankles and stress fractures because the arch does not flatten enough to absorb shock.
To avoid the injuries that often result from overpronation and underpronation, it is important to check the pronation of your feet. This can be done using the simple water test: wet the entire bottom of your foot, then step your wet foot onto a piece of dark, heavy paper or a paper bag. See if your footprint shows about half of the arch (normal pronation), an oblong shape with no space left for the arch (overpronation), or only a thin line along the outside of the foot, next to the space left by the arch (underpronation).
Those with a normal pronation can wear almost any shoe type without compensation for a high or fallen arch. Overpronators can benefit from over-the-counter, molded-leather arch supports, stability shoes, or motion-control shoes. Underpronators should have a shoe with a neutral cushion and softer midsole to absorb shock; they should avoid motion-control footwear.
According to the American Orthopaedic Foot and Ankle Society, women are nine times more likely than men to develop a foot problem due to ill-fitting shoes, and 90% of women say they wear shoes in too small of a size. As a result, 90% of females experience foot deformities because of wearing shoes that are too tight to properly accommodate the length, width, and natural shape of their feet.
Although high heels, or pumps, are a popular staple in many women’s wardrobes as a way to add style, glamour, and even height, high-heeled shoes can lead to a slew of foot, knee, and back problems, such as shortened calf muscles and toe deformities. They can also cause women to alter the way they walk, making them imbalanced and more susceptible to sprained ankles and injuries from falls. Despite the discomforts most women experience while wearing high heels, they continue to wear them, day after day, which compounds the problems that result from high heels.
To minimize the problems stemming from high heels, women can observe the following suggestions: keep the maximum heel height to two inches or under; make sure the shoe fits correctly in all foot areas, such as the heel and toe box; vary heel heights and alternate high heels with flats or low-heeled alternatives; and choose designs of high-heeled shoes made for walking. Do not wear high heels for a time period of more than three hours.
To avoid foot problems, women should wear shoes that offer cushion and support while walking. It is best to choose footwear with laces for additional support and a better fit, rather than slip-on styles. Shoes should have a heel counter that is padded inside with a rigid outside; the heel should be wider instead of narrow and pointy and have a maximum height of 3/4s of an inch. The sole should be rubber or composition for substantial support and grip.
The wear patterns on your worn shoes can be helpful when shopping for new a new pair. Wear patterns can provide information on the fit and sizing of the shoe, your gait, and possible foot and ankle problems and deformities that are impacting the way you walk.
Here are some wear patterns to look for, as well as what they might mean:
- Sole wear: Inner sole wear may indicate that you turn your foot inward when walking; outer sole wear may mean that you turn your foot outward when walking. Orthotics can help provide the necessary foot adjustments for these conditions. If the ball of the foot area is worn, it may reveal a problem with tight heel tendons.
- Toe box wear: Indentations on the upper towards the end of the toe box area may indicate a toe deformity, such as hammertoes, or that the shoes are too small. Wear on the tip of the toe box may mean the front of the shoe sits too low. Wear on the side of the toe box in the big toe area may show a foot deformity, such as a bunion, or shoes that are too narrow.
Familiarizing yourself with the parts of a shoe is helpful when choosing footwear that accommodates your foot shape and size, as well as your activities.
Here are the basic parts of a shoe:
- Counter: The counter is the stiff part of the heel area of the shoe that strengthens the back part of the shoe; it adds support and helps the footwear keep its shape.
- Heel: The heel is positioned at the heel of the foot. It elevates the back part of the foot so it sits higher than the front. The degree of heel elevation varies, and higher heels place more pressure on the forefoot.
- Sole: The sole is the bottom of the shoe that runs the entire length of the foot, from the toes to the heel. The insole is the layer of material that lines the inside of the shoe’s bottom, providing comfort and support. The outsole is the outside of the shoe’s sole that comes in contact with the ground when standing, walking, or running. It should be made of a material that is durable and waterproof and provides a good grip.
- Toe Box or Toe Cap: The toe box or toe cap is the front upper portion of the shoe where the toes are positioned. There are different types of toe boxes, depending upon the activity at hand, ranging from open or decorative to solid or steel for extra protection. The toe box should have enough space to comfortably fit the toes without pressure or restriction. The shape of a toe box can be pointy, round, or square.
- Upper: The upper is the top of the shoe area that covers the entire foot. It is attached to the sole.
- Vamp: The vamp is the part of the shoe where the laces are placed. It covers the upper middle part of the foot below the toe box.
- Waist: The waist covers the arch of the foot, as well as the instep. It curves in a way that accommodates most foot shapes. This curve distinguishes between a shoe for the left foot versus a shoe for the right foot.
Footwear can be made of a variety of materials for breathability, support, shock absorption, and protection.
Unlike women’s shoes, the majority of men’s shoe styles conform with the guidelines for a properly fitting shoe. That is, they accommodate the natural shape of the foot, offer plenty of room in the toe as well as across the forefoot, and have an appropriate heel height of no more than a half-inch. Although the material comprising the soles varies, a softer, creped rubber material is more favorable than a hard bottom such as leather. A cushioned, bendable, and supportive shoe is best for comfort as well as protection. Since footwear should have time to air out to prevent foot fungus and odor problems, it is best to have several pairs to alternate shoes on consecutive days.
Although high heels are a popular staple in many women’s wardrobes as a way to add style, glamour, and even height, high-heeled shoes can lead to a slew of foot, knee, and back problems, such as shortened calf muscles and toe deformities. They can also cause women to alter the way they walk, making them imbalanced and more susceptible to sprained ankles and injuries from falls. Despite the discomforts most women experience while wearing high heels, they continue to wear them, day after day, which compounds the problems that result from high heels.
To minimize the problems stemming from high heels, women can observe the following suggestions: keep the maximum heel height to two inches or under; make sure the shoe fits correctly in all foot areas, such as the heel and toe box; vary heel heights and alternate high heels with flats or low-heeled alternatives (shoes with wider heels and a heel height of no more than 3/4s of an inch); and choose designs of high-heeled shoes made for walking. Do not wear high heels for a time period of more than three hours.
Appropriate footwear for children changes with each phase of childhood. Wearing the proper footwear is critical for correct development of the foot structure, as well as the body’s overall posture.
During infancy, shoes are not necessary, even for beginning walkers, as the main function of shoes is to protect the feet from injuries. In fact, it is advisable for infants to wear just socks or to remain barefoot so the foot’s musculoskeletal system can properly form and gain function without restriction. In this way, the feet will develop strength and the toes will learn to grasp. Toddlers should wear shoes that are soft, flexible, and properly fitted with a toe box that has room for growth and space for the toes to wiggle freely. Children’s footwear should have a stiff heel counter, cushioned insole, and built-in arch. It should also be flexible at the ball of the foot. Sneakers are usually a good choice, and high-tops may benefit children with weak or sprain-prone ankles.
When fitting a child for new footwear, have him or her stand up to properly measure foot size. Remember that feet may commonly be two different sizes; the shoes should be fitted to accommodate the larger of the two feet. A properly-fitting shoe will have about a half-inch of room between the toes and tip of the shoe, which is about the width of an adult’s thumb. Have the child wiggle his or her toes to make sure they are not cramped or restricted. Wearing their usual socks, have the child walk around the store several times to check for redness or irritation that indicates friction or pressure from the shoe.
Since children quickly outgrow their shoes, check their feet regularly for blisters and irritation. Often, children will remove shoes on their own if they are uncomfortable or too tight. Certain foot deformities may require a child to wear corrective shoes, braces, or casts.
Wearing uncomfortable, ill-fitting, or lesser-quality footwear can lead to a host of foot and ankle problems, as well as foot injuries and even foot deformities over time.
Use this checklist to make sure you choose the best shoe to head off foot issues before they start:
- Footwear should have a comfortable, durable design, be made of high quality materials, and protect the feet from injury. A proper fit is top priority (see the suggested shoe fitting guidelines below).
- Never buy a shoe based on looks alone; brand, design, style, and color should come second to a proper, comfortable fit.
- Heel heights of one inch or less, or flat shoes, are best for your feet. If high heels must be worn, do not go higher than two inches and avoid wearing them for periods longer than three hours. The higher the heel, the greater the pressure on the forefoot. The heel counter should be padded on the inside and rigid on the outside.
- Avoid shoes with narrow or pointed toe boxes that crunch and put pressure on the toes.
- Soles should have a good tread to avoid slips and falls; they should also be shock absorbent. Although rubber soles are best, thick rubber soles that extend over the tip of the toe box can cause accidental falls if they snag while walking.
- Uppers should be made of soft, breathable material that offers unrestricted movement.
- Inside the shoe, make sure there are not raised seams that can cause friction and irritation, especially if they rub against problem areas like bunions or corns.
- Laces provide the best fit and support, as opposed to slip-on footwear.
To ensure a proper fit, be sure to stick with the following advice when trying on new shoes:
- Since most people have two differently-sized feet, make sure both feet are measured and the shoe size accommodates the larger of the two feet.
- It is best to try on shoes at the end of the day when feet are swollen and larger from a day’s worth of activity.
- Try on shoes with the socks that you will actually wear.
- All types of footwear should fit comfortably from the start. If shoes are too tight, do not think they will fit better after a “break-in period;” this is a myth.
- There should be a half-inch of space between the longest toe and the tip of the shoe’s toe box, which is about the width of an adult’s thumb. The toes should have enough wiggle room to move around without restriction.
- The heel of the shoe should fit snugly so the heel does not slip out when walking.
- Shoe size varies from brand to brand, as well as from style to style. Make sure you go by how a shoe fits your foot and not just the size marked on the shoe.
- Walk around the store several times to make sure the shoes fit properly when in motion. Check the foot for any redness that could indicate rubbing or pressure.
The type of athletic shoe you wear depends on the movements involved in the sport or activity you will be doing. Wearing the proper athletic shoe provides the support, shock absorption, traction, and protection necessary to keep the foot working properly and free from injury and stress. For running, sneakers need to be light, flexible, and built to absorb impact; tennis and basketball sneakers need to be supportive and able to handle lateral movements, sudden stops, and turns. Cross-training sneakers are appropriate for general athletic activities, such as gym workouts with weights and exercise equipment. If you or your child participates in multiple sports or activities, be sure to have an appropriate shoe specifically designed for each activity.
Athletic shoes should have a comfortable fit to minimize friction, which can lead to blisters and irritation. Depending on the sport, the height of the upper (low-cut, three-quarter-top, or high-top design), the laces, and construction of the sole may vary. Properly constructed athletic shoes have a sturdy construction, leather or canvas uppers, a flexible sole at the forefoot, adequate cushioning, and arch supports.
It is important to remember to regularly replace worn athletic footwear to avoid wear and tear on the feet due to worn soles, weakened heel counters, and evident creasing of the upper. Walking or running shoes should last for about 400 miles. Sneakers for basketball, tennis, and aerobic exercise should be replaced about every 50 hours of wear.
Since diabetics are prone to foot deformities and infections, it is imperative for diabetics to wear proper footwear, even when first diagnosed with the disease. Diabetics can suffer from peripheral artery disease (lack of circulation) and peripheral neuropathy (loss of feeling); as a result, the feet may become susceptible to a slew of problems: ulcers and wounds that do not heal properly, fungal infections, ingrown or brittle toenails, corns, calluses, hammertoes, athlete’s foot, and cracked or dry skin. Gangrene, or dead tissue, can develop, causing bacterial infections that may result in amputation of the affected areas.
Even light, every day activities such as walking can cause issues in the feet of a diabetic, as the bones, joints, and skin are affected by the condition. Therefore, it is important for diabetics to choose footwear that stabilizes the feet, limits motion, and offers adequate support to reduce foot pain and prevent further damage. For example, shoes that limit the movement of affected joints can alleviate inflammation and subsequent pain. Shoes that limit the horizontal movement of the foot against the shoe prevent friction that can cause skin irritation; in a diabetic, friction can eventually lead to ulcers, wounds, and infections, and deformities. Diabetics benefit from shoes that reduce impact, absorb shock, and lessen pressure along the bottom of the foot to prevent wear and tear that can lead to complications.
Special prescription footwear is available for diabetics, including custom-made shoes, healing and post-operative shoes, in-depth shoes that accommodate orthotic inserts (orthoses), external shoe modifications to absorb shock and add stability, and custom orthotic shoe inserts. Custom-made footwear and orthoses are molded from a cast of the patient’s foot and incorporate modifications for deformities, as well as relief from pressure.