If there is one thing that is a common risk factor for this kind of pain, it is footwear. An Australian study of people with osteoarthritis in the knees found that those with pain had higher odds of patients reporting pain in the knees and feet were wearing special footwear. In the case of the feet, too much stress is often placed on its structural components resulting in inflammation and damage to soft tissues, tendons, and ligaments. Footwear can often lead to an increase in the severity of problems that are already present. Typically, symptoms will develop over a period of time, especially if the condition is a degenerative one. This is a very common scenario of events and is often reported by patients with different types of arthritis and rheumatic diseases.
Common causes of foot and ankle pain, sore or tired feet are very common symptoms that usually result in a visit to a podiatrist. Pain is your body’s way of telling you that something is not right, but it’s not always easy to determine the exact cause. Although you would think that the feet are the most likely area of the body to suffer from pain, it is often quite a surprise when the patient is asked to pinpoint the location of the pain. Sometimes pain is not coming from the area in which it is felt. An example of this is ‘sciatica’ where a nerve in the lower back is compressed causing pain and numbness in the leg. Other common types of pain in the lower limb may consist of aching discomfort, sensations of burning or tingling and swelling.
Importance of Footwear in Foot and Ankle Health
Similarly, support and torsional rigidity within a shoe are of vital importance for people with pathologies such as posterior tibial tendon dysfunction, where the requirement is to stabilize the foot and reduce the tension on the medial longitudinal arch. Failure to match the requirements of the foot and type of pathology to the correct footwear will invariably increase the chances of onset or a worsening condition. This information clearly demonstrates the major influence footwear has over foot and ankle health.
One of the key influencing factors of this movement is the role of the footwear that is being used. As previously highlighted, during the stance phase, the foot will adapt to the shoe it is wearing. If the shoe is old and has impaired cushioning, the foot will become a more rigid lever, which can increase the chance of pain at the first MPJ due to a lesser windlass mechanism. This, in turn, will increase the stress through the joint, increase the chance of hallux limitus, and then further increase the stress on the lesser toes and metatarsal shafts. This has a knock-on effect right up through the kinetic chain to the spine. It is clear that this can be a devastating sequence of events that have stemmed from the simple insufficiency of footwear.
There are several factors that can affect the health of the feet, which can in turn increase the stress put on the joints in the foot and ankle. The feet have a dynamic role during gait. The change from heel strike to toe off requires the foot to adjust from a flexible structure to an almost rigid lever. This is important in order for the foot to effectively propel the body forwards.
Common Causes of Foot and Ankle Pain
Some common causes of foot and ankle pain include standing for a great deal of time or putting too much weight on the feet, and using improper footwear for an activity. This may lead to overuse or stress on the foot or ankle, which can cause an injury. A fall or sudden trauma such as a sprained ankle or broken foot can be a painful experience. Rapid or severe weight changes can also cause feet to become painful. This can be due to the increased stress on the feet from extra weight or from the development of systemic diseases secondary to the weight change. Finally, pain in the feet and ankles can be a result of general wear and tear in the structures of the feet, which happens as we get older and spend more time on our feet. This is a common problem and can cause the development of arthritis in the feet. Arthritis can cause moderate to severe pain in the foot and ankle, and it may limit activity.
Characteristics of Supportive Shoes
Sizing is an obvious yet commonly overlooked consideration when purchasing appropriate footwear. A shoe that does not conform to the length, width, and shape of the wearer’s foot can cause discomfort and also make the foot more susceptible to injury. A previous study on professional baseball players showed that poor shoe sizing is a risk factor for certain foot and ankle injuries. Size discrepancies were attributed to style and brand preference, in conjunction with irregular foot morphology. Ill-fitting shoes can cause skin friction blisters, calluses or corns, nail problems, mallet toes, hammer toes, bunions, and plantar fasciitis. A properly sized shoe should maintain total contact and/or close to the foot in the rear, mid, and forefoot, and have a toe box of adequate height and depth.
Cushioning has been characterized as a mechanical buffer implemented to absorb energy and impact between the foot and a hard surface, therefore reducing discomfort and preventing injury. Shock absorption capacity has been defined as the measure of the energy absorbing characteristics of a material independent of or under the influence of pressure. Many studies have confirmed the relationship between high impact forces resulting from inadequate cushioning and various injuries to the foot and lower limb. Shoes lacking cushioning and shock absorption will fail to attenuate impact forces, increase peak plantar pressure, and possibly cause or exacerbate injury to the foot and ankle. This makes cushioning and shock absorption two of the most important factors when considering footwear for those with foot and ankle pain.
Arch support has been defined as the ability of a shoe to take pressure off the wearer’s plantar surface by cradling the arch and heel. It is suggested that most people with foot pain have a structural and/or functional deformity pertaining to the arches of their feet. The longitudinal arch depends on the plantar aponeurosis and other plantar intrinsic muscles and ligaments for support. Any injury to these structures can result in a lower or higher arched foot, and ultimately pain during weight bearing activities. Shoes with arch support will benefit those with both conditions by maintaining the foot in a neutral position in addition to increasing the height of the medial longitudinal arch during stance and gait.
Arch Support
In the case of orthopedic footwear, there are a number of ways in which the arch support can be implemented. Often the correct will be molded to a cast of the patient’s foot – though this could be expensive. The widespread use of heat-moldable materials has seen a significant increase in the customization of arch support in shoes or boots. One new technology in that is the use of thermal fibers. Heating the fibers to a certain temperature can enable them to be shaped to the desired form. When cooled, the fibers harden and maintain the shape. With the use of computer-aided design, this style of arch support customization can be very precise and easy to replicate.
A typical thought is that the firmer the arch support, the better but that is not always the case. There may be actually little evidence to suggest that the firmer the arch, the more corrective it’s going to be. In fact, an arch that’s too rigid could cause pain and damage so it is essential that the arch support adapts to the wearer’s foot. This was investigated in a study by D’Aout et al who looked at the effects of high heeled footwear on the feet to evaluate their performance as an arch support. They found that the shoes can be extremely effective in aiding the foot arch. This reduced the tension in the Achilles tendon and the muscle-tendon complex across the ankle, reducing pressure across the foot and ankle joints. This reveals that the right arch support is beneficial to foot and ankle health, particularly for individuals who may already have a joint dysfunction.
Determining whether a shoe supplies the correct quantity of arch support is vital. The easiest way to test that is to take the shoe in query and carry out the ‘bend’ test. If the shoe can be bent anywhere along the sole, it does not provide enough support. Shoes or boots which have inadequate arch support can result in muscle fatigue, leading to pain within the hips and lower back. It may also result in discomfort across the knees, and in the worst case situation, could cause flat feet! Years of working and standing on hard surfaces have left me with a need for substantial arch support in my footwear. I currently wear orthotics in my footwear, and I find that they work best when I’m wearing a shoe with good arch support.
Cushioning and Shock Absorption
The next logical step is to examine how footwear cushioning and shock-absorbing capabilities affect impact on the human body. Several studies have shown that as little as a 10% loss of midsole thickness can cause increased discomfort in running. More recent studies have focused on energy absorption and return of different footwear. This is to simulate the actual function of footwear during dynamic movement. It is thought that energy-absorbing footwear will be able to decrease musculoskeletal stress by attenuating transmitted impact. This will essentially decrease fatigue during prolonged activity. During running, energy return is thought to give greater propulsion, adding to the overall efficiency of the runner. These types of studies were initially designed for athletic footwear, but the principles can be directly related to occupational and everyday footwear. In conclusion, cushioning and shock absorption can greatly affect the way a person moves and feels, whether it be positive or negative.
Cushioning and shock absorption of footwear have been a study of great interest in relation to overuse injuries. In fact, many studies have been done concluding that the rate of injuries in running sports, for example, has not decreased since the advent of the modern running shoe. Results have led to the hypothesis that the harder the surface, the higher the impact and greater occurrence of injury.
Proper Fit and Sizing
To ensure proper fit, be sure to have both feet measured when selecting a shoe. If one foot is larger or wider than the other, it is best to buy a size that fits the larger foot. Most people have one foot that is larger than the other. Be sure to get the length, width, and depth of the foot measured. Shoe sizes change as a person ages, and getting the feet measured can determine the proper shoe size. The length of the shoe should be 1/2 inch longer than the longest toe, which may not be the great toe. This ensures there is enough room in the shoe for the foot. The width should be snug, but there should be ample room in the toe box. The shoe should be the proper length and width from the get-go. There is a common misconception that a shoe can be broken in to make it fit better. A shoe should never be too tight, as the material will not stretch enough to make a considerable difference. The depth of the shoe is important for those with foot deformities such as hammertoes. A shoe with adequate depth will help alleviate friction on the top of the toes.
Footwear fit is an important, yet often overlooked part of the shoe selection process. A properly fitted shoe can make the difference between an enjoyable, pain-free day and a foot pain-filled day. A proper fit means a properly fitting length and width. The shoe should conform to the shape of the foot and not the other way around. Wearing shoes that are too big can cause a number of biomechanical problems, including gait abnormalities such as supination and overpronation. Conversely, a shoe that is too small can cause friction injuries such as blisters and calluses, corns, hammertoes, and bunions.
Stability and Motion Control
Motion control is a term used to describe shoes that are designed to limit excess motion. A motion controlled shoe should limit unnecessary motion at the foot and the ankle. Excess motion has been thought to be a contributing factor in the development of numerous types of overuse injuries. These injuries often occur with prolonged amounts of weight bearing activity and can be particularly debilitating. Often times the motion that is trying to be limited is excessive pronation. Over time excessive pronation has been thought to reduce the body’s ability to store and return mechanical energy. This is often described by comparing the foot to a car’s shock absorber. If the pronation is too great, the potential energy in the shock (the foot) cannot be transferred to kinetic energy (movement). The rebuilding of the foot into an effective ‘shock absorber’ can be a significant contributing factor to pain in the foot and the development of conditions such as tibialis posterior dysfunction or plantar fasciitis.
Shoe stability is the ability of a shoe to support and hold the foot in proper position. There are two kinds of shoe stability: intrinsic and extrinsic. Intrinsic stability is the result of the shoe’s construction. Less flexible materials in the upper or the use of a medial post can increase intrinsic stability. Extrinsic stability is the stability of the foot-shoe combination. This means that a shoe with high intrinsic stability may not provide effective extrinsic stability for some individuals due to the shape of their foot or other factors.
Benefits of Wearing Supportive Shoes
A study comparing the effects of three different types of sandals on patients with rheumatoid arthritis found that those wearing the supportive sandal experienced significant improvements in rearfoot motion and comfort after 6 weeks, while those wearing the flat flexible sandal experienced increased levels of pain and disease activity. This demonstrates that all the features of a supportive shoe work together to decrease the load on the foot and specific regions, in turn decreasing pain and discomfort in patients with various foot conditions. The study has important implications for patients since pain reduction is a key priority for those suffering from chronic foot conditions.
Reduction of foot and ankle pain: The most effective way to reduce pain from foot conditions is to decrease the amount of time the foot is under load and increase the area over which the load is spread. Supportive shoes do this by providing a stable platform for the foot, which reduces the load on uncomfortable or painful areas and helps to realign the foot into a more comfortable position.
Reduction of Foot and Ankle Pain
Wearing supportive shoes can help to reduce or eliminate foot and ankle pain. There are many different conditions that can cause pain in the lower extremities, and thus many ways in which shoes can alleviate the symptoms. Pain is usually located underneath the heel or at the forefoot. One very common cause of forefoot pain is called metatarsalgia. This condition causes sharp or aching pain and inflammation in the ball of the foot. It is often aggravated by walking in thin-soled shoes. Shoes with a rocker bottom sole are effective in offloading the metatarsal heads and reducing the symptoms of metatarsalgia. This is because the sole is designed to reduce the amount of bend in the forefoot, which results in less pressure on the sole of the foot. Shoes with a stiff sole and rocker bottom are also effective in offloading the plantar fascia and can reduce the symptoms of plantar fasciitis. These types of shoes also alter the way the foot contacts the ground and can be effective in reducing muscle activity around the ankle and thus reducing fatigue and pain in those with arthritis.
Prevention of Injuries
In addition to acute injuries, inadequate footwear has also been linked to the development of overuse injuries. A well-known example of this is the stress fracture. This is often known as a condition of military recruits, but it can occur in many populations with increased amounts of weight-bearing activity. Commonly occurring at the metatarsal bones and tibia, stress fractures are caused by repetitive loading of a bone that has not had sufficient time to rebuild itself and results in a fatigued area of the cortex. At each heel strike, the lower extremity must absorb 1-1.5 times the body’s weight. Thus, the additional impact from a lack of cushioning and/or poor shoe fit will increase the likelihood of a stress fracture.
Previous studies have linked high-heeled shoes to an increased risk of ankle injury. The chronic use and repetitive nature of ankle inversion during the heel-toe gait pattern in high heels can cause mechanical weakening of ankle musculature. Increased ankle instability and therefore a greater risk of inverting the ankle while walking on flat ground in normal shoes. This may result in lateral ligament strain or repetitive ankle sprains. Another specific form of injury is the calcaneal stress fracture due to repetitive heel strike on hard surfaces in shoes that lack sufficient shock absorption. In a study, the use of a flat, flexible shoe with a semi-rigid orthosis was found to reduce pain in patients with calcaneal stress fractures. This is also relevant to the general population, where increased shock to the lower extremity has been linked to knee pain and osteoarthritis in the elderly.
Improvement of Posture and Alignment
This cause and effect of the movement up the kinetic chain can easily be compared by changing the alignment of a tire on a car. When a tire becomes misaligned, various problems will arise in other parts of the car. By fixing the alignment of the tire, one can prevent these problems from occurring. This is the same principle as changing the alignment of the foot to prevent problems in the rest of the body.
The premise that footwear can change alignment and posture is based on the kinetic chain. The kinetic chain is the concept that the joints and segments of the body are connected to one another, and that any movement of the chain starts from the distal segment and moves proximally. In the context of movement, the kinetic chain starts at the foot. If the foot has a problem, the problem will transfer up the chain to the rest of the body. Because over-pronation disrupts the movement of the foot, it will have various effects on the rest of the body. By wearing supportive footwear that combats over-pronation, one can effectively prevent future problems of the kinetic chain all the way up to the back and shoulders.
Symptoms of over-pronation include internal rotation of the knees, back pain, and internal rotation of the shoulders. By wearing supportive footwear, the feet will be stabilized and realigned, which will prevent the aforementioned symptoms and provide a solution for the poor alignment of the rest of the body. This will also reduce the amount of stress being applied to the body’s joints and muscles. In essence, it will help create a more healthy and efficient walking pattern, which can greatly improve posture and prevent further problems in the future.
There have been numerous studies that assess the way in which footwear can affect the posture and alignment of the body. These studies have shown that supportive footwear increases the stability of the lower limbs, which in turn improves posture and provides reinforcement to the foot’s arch. This prevents the arch from collapsing, subsequently preventing over-pronation. Over-pronation is a common biomechanical problem that occurs in the walking process, wherein the arches collapse and the feet and ankles roll inwards. This can create a series of problems not only for the feet and ankles, but also for the rest of the body.
Choosing the Right Supportive Shoes
When considering what characteristics are most important in choosing the right supportive shoes, the two most commonly cited factors are understanding your foot type and considering your daily activities. Understanding your foot type is important in determining what kind of shoe your foot requires based on the three common foot types – the low arched/flat foot, the neutral foot and the high arched foot. People who require more support have the low arched/flat foot and the high arched foot, and do best in a motion control shoe and a cushioned shoe with extra shock absorption and enhanced stability, respectively. People with the neutral foot can use stability shoes, which provide the right amount of support and durability. People who require less support are generally more comfortable in a flexible cushioned shoe. This is a bit more complicated because of the varying degrees of foot type. Recent research has been done on the effect of shoe inserts on kinematics, kinetics and muscle activity in symptomatic hallux abducto valgus (bunions), which shows how different shoe inserts can be used to affect the foot and leg. People with rearfoot pronation found comfort in harder, more supportive shoe inserts. With a more supportive shoe insert, there is a decrease in pronation and the size of bunion deformity. However, shoes with a reinforced heel counter and an increased sole hardness have shown to increase the chance of ankle sprain in participants with chronic ankle instability. In treating specific foot pathologies, the type of shoe must be carefully considered.
Understanding Your Foot Type
The best way to understand foot type and the mechanics of your feet is to look at them wet. The bottom of the foot will show a wet spot connected to the type of arch the foot has. A person with a high arch has a wet mark that is connected to the heel and the toes with a small strip on the outside of the foot. High arches tend to be rigid and lack absorption, leading to foot pain. A person with a normal foot has a wet mark that connects the heel and toes on the inside and outside of the foot, the connection on the inside of the foot is approximately half the width of the foot. A low arch, often called flat feet, has a wet mark that connects the heel and toes with a large connection on the inside of the foot. Low arches cause the inside of the foot to rub and the foot to roll, often causing pain in the foot and leg. This information can help you in finding out if you need additional support or cushion in your shoes. High arches often require a cushion insert and a stiffer form of foot support. Low arches often require added support with a custom orthotic and shoes that have a straight last.
Considering Your Daily Activities and Needs
High-heeled shoes are generally not comfortable for long days on your feet, but may be required with certain types of dress. If you must wear high-heeled shoes, limit the time you have them on, and bring another pair of shoes to change into if possible.
When selecting daily wear shoes, it is usually best to choose a shoe with laces and some type of a functional support device inside the shoe, such as a removable insole. This will allow you to modify the shoe to better fit your feet. Because feet swell during the day, it’s usually best to buy shoes in the late afternoon or evening. Some people may require two pairs of shoes by buying a larger size when their feet are swollen. Avoid tight-fitting shoes, and those with narrow toe boxes. Good support is often found in leather shoes. Avoid lightweight shoes which may provide little support. A simple slip-on flat shoe may be comfortable for short periods, but may not be the best shoe if you are going to be on your feet all day. Remember that the effects of most shoes are determined by the mileage you put on them. A simple pair of sandals may be comfortable when you first buy them, but provide little support after several months of wear.
It’s a good idea to think about the types of activities you generally do each day. For most people, a mixture of supportive shoes for daily wear, casual shoes, and a good pair of supportive athletic shoes should provide comfort and function. There are many different types of shoes, and some may be better than others for your needs. Remember, within each category of shoes there are vast differences and there is no one type of shoe that is best for everyone. In general, good shoes should be comfortable, functional, and provide adequate support. This is also true for athletic shoes.
Professional Fitting and Advice
The shoe fitting process at a specialty store is different from that at a chain store. The fitter will measure both your feet, as it is not uncommon to have one foot larger than the other. The overall fit of the shoes you choose should be appropriate for the larger foot. Because there can be variations in shoe sizes between brands, it is very important to always try on the footwear and not just rely on the size. The fitter should gauge the size of the shoes you try on while you are standing, as feet will slightly swell and elongate with activity during the day. So the products are best fit to the largest version of your feet. It is wise to shop for shoes in the afternoon or evening as opposed to the morning. This is when your feet are largest.
Visiting a specialty shoe store with trained professionals who can assess your gait, foot type, and any mechanical abnormalities is the ideal situation. A foot assessment will include a detailed history of your foot health, a check of the shoes you are currently wearing, an inspection of your foot type, and a gait analysis. It is important to bring in old worn shoes because the wear patterns can be examined to aid in making footwear recommendations. Be sure to take your orthotics with you so the fitter can suggest appropriate footwear. A list of the activities you perform on a regular basis can also help the fitter find the most suitable footwear for you. There are certain lacing techniques and modifications to your footwear that a shoe fitter may suggest to help accommodate deformities, pain, or gait abnormalities.
