Patient Information: Choosing Shoes
A shoe is basically a package. But it is a package for delicate object-your foot. Obviously if the package is the wrong shape, or made of wrong materials, your foot can be damaged. So choosing the right shoes is important for anyone, but especially so if you suffer from foot problems.
It might seem odd, but beautiful feet are rarities in western, shoe-wearing societies. In hot countries, where people go without shoes, or wear sandals, ugly or deformed feet are comparatively rare. That says something about the shoes we choose.
Naturally because of our climate and our urban environment we have to wear shoes as protection against the elements, and the right footwear can make a lot of difference. But even if the damage has already been done, or you suffer from arthritis or bunions, care taken now can help make your feet more comfortable.
Size of the shoe
Selecting the right size of shoes is a basic necessity. The size printed on the shoe, however, is less important than how it feels. Your foot should not be able to slide about too much, but there must be room enough at the front for the natural forward movement of your toes which occurs in motion of walking or running.
Soles of the shoe
These should be light, pliable and hard-wearing. In a wedge-type construction (for instance a shoe with a pointed toe), the sole should be able to bend along a line which could be drawn from the joint at the base of the big toe to the base of the little toe. The best soling materials these days are the moulded or microcellular rubbers which have displaced heavy leather.
Leather is still by far the best material for the upper of a shoe. Man-made plastic “leathers” such as you have foot problems. Women with “difficult” feet find that basket-weave uppers are the most comfortable. Both dark colours and a suede finish disguise misshapen feet. You should avoid toe caps. Ornamental stitching, brogue styles and, paradoxically, the most expensive calf leathers all reduce the ability of the upper to mould to the shape of your foot.
To stop your foot sliding backwards a shoe needs the reinforcement of a heel counter in the heel cup. A sandal requires a sling strap to perform the same function.
The best way to stop your foot sliding forward is to contain the ”waist” of the foot. Lance-up shoes do this most efficiently; alternatively a Velcro flap or an elasticated panel can do same job. In court-style shoes only the pressure on the toes acts as a buffer.
This area of the shoe keeps its shape by means of reinforcement built into it. It is also known as the toe puff. The toe box should provide at least one centimeter of room beyond your longest toe.
Checking shoe length
Here is a quick and easy way to check if a shoe is the right length for you. Take a strip of flexible card one centimeter wide. Place your foot lengthwise on the strip and mark where your heel and longest toe come. Cut the strip to this measure and place it inside your shoe (or take it with you when you are buying) with one end of the strip flush to the heel. You should be able to slide the card forward at least one centimeter.
Although we were not born to wear shoes with heels, walking is more comfortable with a low heel (about one centimeter) than with none. Women who have always worn high or medium-height heels usually find it difficult to adapt to low heels later on in life.
Walking shoes, sports shoes and some others have a low, reinforcement wall to stop the foot from sliding sideways. In some sandals or “flip-flop” the same function is performed by a small pillar between the first and second toes.
Constriction of the toes is the chief cause of deformity in children’s feet. It starts when babies are put into stretch socks and continues if children wear shoes they have outgrown. Adolescent girls (and boys) can rick the health of their feet when they become more fashion conscious and refuse to accept “sensible” footwear.
It is worth encouraging babies and young children to trot around in bare feet or in sandals wherever appropriate. Beyond this, great care should be taken to make sure that all footwear, tights and socks, as well as shoes, fit well and do not compress the feet, especially the toes. Deformities that are acquired before the age of ten may correct themselves naturally as the foot grows. But damage acquired and still remaining up to and during adolescence will be irreversible.
Teenage feet are supple and can often be squeezed painlessly into shoes that are too short or too narrow, but at the same time they are still growing rapidly-often as much as one centimeter in six months. Consequently, a shoe which fits perfectly in January will be either too short or too narrow by July.
Bunions (Hallux Valgus)
These usually start in childhood and are the direct result of shoes that are too tight. Pointed shoes and court-style are further culprits. The weight of the foot is only kept from sliding forwards by the wedging effect the toe box has on the front of the foot-an X-ray would show this clearly. The toe will inevitably be compressed and, when the shoes are too short or too pointed, bunions are more likely to be caused. These are also more likely if the inner border of the shoe is not straight.
Girls with naturally broad feet face worse problems than normal, since very few fashion shoes are made in more than one or two widths. Damage can, of course, be limited if people wear “sensible” shoes for work and reserve fashion shoes for special occasions.
Boys often develop damage because they tend to wear expensive football boots after they have ceased to fit properly. Training shoes have superseded the old gym shoes, which is just as well, since they are better padded and ventilated. Unfortunately, they are seldom manufactured in different widths so, once more, people with broad feet suffer. But it is possible, by shopping around, to find wider shoes for sport
Industrial and safety shoes
Workers on building sites need soles that include a steel plate to protect the foot from the underside. Armoured toe caps are necessary when there is a danger of falling heavy objects. Oil-proof or non-skid compounds may be required if you work in a garage or oily surroundings. If you need rubber boots for outdoor work, you face the same old problem of only one-width fitting. Do not tolerate a boot that is too narrow. Instead, buy a size bigger and pad it with extra socks.
If you have unusually-shaped feet you can probably be fitted with “depth” shoes often available from chiropodist or the National Health Service. These have the deeper last to accommodate a moulded insole. You may find that you can get the broader width of shoe you need from a mail order company such as the Bury Boot & Shoe Company, Bury, Lancs. The National Health Service, free of charge, provides custom-made shoes for people with foot deformities, if they can provide a prescription signed by a hospital consultant. This service will vary between areas depending on which shoemaker is contracted to the hospital concerned.
A fully hand-crafted pair of shoes could cast the NHS as much as £300! However, proper comfort and satisfaction can usually be found less expensively with “depth” shoes. Also available through the NHS at less cost are shoes made to a plaster- of-Paris replica of the foot in question-constructed from soft leathers bonded to a microcellular sole and padded with modern foam plastics. These are particularly suitable if you are suffering from arthritis in your feet.
Advice on where to get these special shoes can be obtained from the local occupational therapy department.
Special arthritic problems
Early rheumatoid arthritis: Many women manage with sandals in summer and fur-lined boots in winter.
Bad circulation, cold feet: Insulated boots such as “moon boots” are helpful. N.B. There is a danger in wearing these boots for too long as there is no ventilation in them.
Working in the wet or mud: As a substitute for rubber boots, put surgical shoe which inside galoshes or shoe over boots. These are comfortable, warm and waterproof.
Stiff ankles: If your ankle is stiff and you can’t point your toes, you will need: (a) exactly the right heel height; (b) shoes which lance right down to toes (these are available in some fashion styles, or, to order, in NHS footwear).
Arthritic fingers: If your fingers cannot cope with normal laces, try elastic laces (obtainable from hospital occupational therapy department) or shoes which use a Velcro flap. Otherwise you could buy zip-sided boots and have a split-ring placed in the zip which you can pull up with a hook on a stick.
Hallux Rigidus (the big toe is stiff and will not bend upwards):You will need a simple modification to the sole of the shoe so that the foot rocks over the sole instead of the big toe being forced upwards.
Chiropody:People with hard skin, corns, in-growing toe-nails should have these attended to before trying shoes on. If chiropody padding is needed, this should be in place before shoe fitting-otherwise the shoe which seems big enough without them be too tight with them. Similarly, if you need shaped insoles taken them along with you to the shoe fitter.
Really bad feet (shoes impossible): Hospitals can supply disposable foam plastic “Dru” shoes, which can be padded or cut to fit almost any foot. People with foot ulcers, bulky dressings, protruding toes or awaiting surgery can use these as something to get around in. if soiled they can be washed in a weak solution of bleach and detergent.
- 6-8 million people are significantly affected.
- child in every 1,000 suffers from a juvenile from of the disease.
- Only 1 person in 50 will escape some form of rheumatic complaint.
- Arthritis costs 88 million lost working days a year.