Living With Chronic Pain

Do Shoes Matter?

It’s hard to imagine what goes on your feet can impact your overall health. But it does. Poorly fitting, unsupportive, or too high or low a heel can cause issues in your legs, knees, back, hips and even your neck. Fashion sounds great until the resulting pain speaks louder. Thankfully, the shoe industry seems to be getting on board with a wider variety of options.

My back became an ongoing issue in my 20’s when the saddle on my horse broke and sent me flying a few feet onto the hard packed ground. After that first ruptured disc, back pain became a part of my life. Endless days and nights as a resident were too painful in anything but tennis shoes- the only low, supportive shoe available at the time. Since then manufacturers have realized comfort and fashion can coexist.

One of the things I notice when assessing patients who have back and leg pain are their shoes. All our weight rest solely on our feet. Staying aligned is crucial. Shoes provide that critical support. Check out your arches. Are they normal, high or flat? Each will make a difference in the type of shoe you should be wearing. Fallen or flat arches put pressure on the inside of the legs and knees which then creates balance issues in the hips and lower back. A high arch puts pressure on the outside of the legs and knees again translating to imbalances in the hips and back. Add to these improperly fitted shoes and they can cause long term wear and tear to the spine, especially the vertebrae and intervertebral discs. Every time we move our ankles, knees, hips, back and neck rely on everything staying aligned and balanced.

Even a short duration in the wrong shoe can stress and hurt bones, joints and the surrounding soft tissue. Where your feet move, the body follows. When walking correctly the heel makes contact first then the arch rolls slightly inward allowing the ball of the foot and then the big toe to follow. The heel then lifts off the ground pushing us forward from the ball of the foot and toes into the step on the other foot. It’s symmetrical, balanced and second nature. Perfectly choreographed without a thought. Until pain intervenes. Then the breathtaking dance is altered. We may not even realize the damage until it’s too late. Just like the saying “the straw that broke the camels back,” that irritating ache throughout the day, can’t wait to get them off when home. Then desperately needing a weekend to recover, are all signs it’s time to get new shoes. By the time we understand theirs an issue it’s often been brewing for awhile.

After multiple neck, thoracic, lumbar and foot surgeries I can attest to how each one affects the entire body’s ability to stand and walk normally. Add to that bad shoes and the consequences are horrifying.

Poorly fitting shoes increase the likelihood of getting corns, bunions, blisters, hammertoes, and plantar fasciitis. Eventually the entire leg and back can be impacted, causing problems at work, anytime standing or walking extended periods of time is required, and our performance when playing sports. The more the body has to adapt the more it recruits other areas, until even your neck is involved. Whatever the activity, good fitting shoes can be the determining factor in how we accomplish our goals.

Most of us overestimate the life of our shoes. As a runner many decades ago, I loved one particular pair of shoes and wore them religiously on my daily two mile run for years. Unfortunately, at that rate, their life ended within a year and they were actually contributing to ongoing wear and tear on my back. Here are signs to look for that say it’s time to chuck those priceless boots from the 1990’s or fabulous pumps from 2010!

  • Look for wrinkles in the middle of the foot, heel or around the edges of the sole. Leather can stretch and fabric can tear with time altering the support and fit. Are they frayed? All are signs it’s time to get a new pair.
  • *Just like the tires on our cars, look for wear patterns that are excessive, uneven or angled. Put them on a table and see if they lie evenly and look symmetrical. If they rock or one side is worse then the other seek help in how to better fit shoes for your particular needs.
  • *Check out the heels and soles. Are they frayed or worn out? Often if this is the only issue and you can’t bear to let those shoes go, a shoe repair shop can replace the damaged parts.
  • Make sure the width fits. If your foot looks like it’s rolling over the edge and stretching the side increase the width. Too narrow is just as bad as too small. Make sure you have 1-1.5 cm at the end of each shoe so the toes can wiggle and the shoe is snug but not tight in any direction. They should grip your heel so it doesn’t slip with movement.
  • Support is essential. Sometimes something as innocuous as an ankle strap can make the difference between slip-sliding the day away. This creates better stability and prevents the tendinitis and muscle pain that can occur from trying to keep them in place.
  • A rigid heel can better absorb shock when walking and a rigid midsole disperses weight throughout the foot. Laces can add even more support especially when they are tied snugly to the foot. A rigid shoe helps us to maintain our center of gravity, requires less push off strength and encourages proper alignment with less chance of fatigue.
  • Cushioning is imperative when standing and walking on hard surfaces. Even carpet over concrete, as in most businesses, is too hard. And remember, if you have those wonderful go to shoes you’ve worn for years, it may be time to chuck them in the garbage and find new ones.
  • Get your feet measured regularly. What you wore a year ago may not be appropriate today. Feet change in shape and size over time, due to age, weight, wear and tear, and gait. It’s also common for one foot to be larger then the other.
  • Try on shoes when your feet are their largest- at the end of the day or after exercising. This will ensure the best fit throughout the day.
  • If they aren’t comfortable in the store no amount of “working them in” will help. Listen to your body. Walk a bit around the house. If they don’t feel good from the get go, let them go!

The right shoe can make a huge difference in preventing long term issues and pain. For those of us who suffer already they can be integral to keeping it tolerable. It’s not a matter of if shoes impact our pain, it’s a matter of seeing how much.

Next week I’ll discuss what shoe configurations are better and which are worse. The answers might surprise you.






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