26 bones, 33 joints and over 100 muscles, tendons and ligaments in the foot have to support our entire body weight for any and all activities throughout the day. One of the first things I look at when a patient has pain complaints are the backpacks, briefcases, purses and especially the shoes they are wearing. All have a huge impact on pain. It makes intuitive sense why carrying heavy baggage can impact pain, shoes can be harder to explain.
Except when it’s obvious. I’m always impressed by women who’ve had years of foot, leg and back pain who walk in on stiletto heels. Stylish, yes, supportive and healthy for the foot, no. Yet even those seemingly innocuous sandals or tennis shoes can still be the culprit.
Anything that changes your gait can affect your feet, ankle, knees, hips, pelvis and spine. Pain sufferers compensate by putting less pressure on the affected area. This alters the impressive balance our bodies achieve when active. Shoes are often the reason or contributing factor. Restoring it is imperative. Every one of my spinal fusions and foot surgeries altered the symmetry and incredible choreography my body naturally performed, irretrievably altering my alignment. Add bad fitting shoes and the combination can be catastrophic.
From untested new shoes, to well-worn joggers, to sandals and then pumps or boots depending on the weather, to bare feet- they all encourage a different foot strike. Every time we change our footwear it impacts our gait and ultimately our pain.
High heels play a major role
The higher the heel, the worse the risk becomes. High heeled shoes, especially stilletos, cause some muscles to relax while excessively stressing others. This imbalance often translates into low back pain. It’s like performing on stilts. A tiny spindle has to take the weight of the entire body, forcing us to maneuver in ways never imagined to stay upright. They can shorten and tighten calf muscles, making the quadriceps work overtime. This adds incredible stress to the knees, inner thighs and butt muscles. To keep us standing and walking they push the chest forward and require the pelvis to tilt forward and backwards, left and right, demanding intricately connected muscles and joints in the spine accommodate. They change the center of gravity- our natural posture and positioning in space. Long term this “torsion” leads to damage and pain. Wider heels are better but still create the same issues in the long run. They may make our legs and bottom look incredible but at what price?
Love those flip flops?
These seem harmless. A simple, light weight, flat shoe that gets us through the summer heat. But without necessary foot, ankle or arch support, cushioning or shock absorption, they ultimately cause strain on muscles, ligaments and joints throughout the feet, legs and back. And the only thing keeping them on your feet are bent toes. A tenuous tether at best. Most of the time the shoe is doing exactly what it’s called- flip flopping in all directions- demanding the rest of the body accommodate the need to keep them attached. For those who like to add a heel to flip flops all those issues are exacerbated by forcing the body to shift its center of gravity forward. The back then has to arch to compensate. Even adding a simple strap around the heel can make a difference. The toes stop scrunching up to keep the shoes in place (leading to hammertoes!) and the heel stops rotating side to side. Can’t live without them? Buy ones with a sturdier sole, replace them every 3-4 months, and don’t wear them to drive, play sports or walk long distances.
Are flat shoes better?
No, they cause the Achilles tendon to tighten, putting a strain on the plantar fascia- that band of fibers and muscles that runs along the sole of the foot. This can result in flattened arches which can damage feet, ankles and knees. Love those flat ballet shoes? As cute as they are, flat, unsupportive shoes can also cause the Achilles tendon to be overly stretched, putting pressure on the heel. Because there’s little or no shock absorption from the shoe itself, every time the foot hits the ground the impact translates from the foot up the legs. They also cause the foot to roll inward, pushing the knees and hips out of alignment.
Poor arch support
Who thinks about arches when buying shoes? But it’s critical to maintaining balance and easing or preventing pain. There are generally two types- high arches where the curve between the ball of the foot and heel is high, or flat where it’s closer to the ground. Truly “flat feet” where there’s no arch at all, are rare. Supporting your arches so they can then support your feet and legs can make all the difference in future wear and tear leading to pain. Insoles might help. If you have flatter feet go with a stiffer one, higher arches a more cushioned one. Not sure? Talk to a podiatrist to get accurate information on your specific needs.
Tennis shoes must be a perfect alternative, right?
Don’t just buy them for how they look. Think about what you do all day or the particular sport you engage in since each is styled for specific activities. Walking shoes are made with forward momentum as the top priority. They include good arch support and cushioning in the ball of the foot and heel. Tennis, basketball, and dance shoes all take into account the need for rapid side to side motion. Running shoes are built to absorb the impact and prevent twisting that can lead to heel pain, shin splints, tendinitis, stress fractures and overuse injuries. Are you on grass, cement, hard floors, carpet all the time? Each will change the recommended parameters.
Is walking barefoot best?
You might think so, but constantly walking on hard surfaces like that gorgeous tile, marble or hardwood floors in your house can stress the feet and exacerbate or cause pain over time. We all have fat pads on the balls and heels of our feet. In time these can be worn down. If this is the case, wearing a metatarsal pad in your shoe to relieve pressure beneath the big toe and ball of the foot may help by distributing the pressure more diffusely. Trouble at home? Try wearing slippers with cushioned soles and throwing down memory foam mats where you stand a lot ie bathroom and kitchen sinks. I can’t tell you the relief I’ve gotten from these simple but incredibly effective additions.
The answer is a moderate heel height
I know it may sound counterintuitive, but a small heel is really the best option for those of us suffering from low back and leg pain. It took me years of trial and error. I’m not much of a Birkenstock lady but early on I tried anything just to feel better while working long hours. Realizing a small heel in a stylish shoe worked best was a dream come true. When our heels are slightly elevated it alleviates pressure on the feet and allows the ankle to turn a little bit and rotate differently. A flat or high heel on the other hand changes how the entire leg and pelvis move which ultimately impacts the spine. The American Podiatric Medical Association recommends anything under two inches. I find 1 to 1 1/2 inches is perfect for me. Round toes are always preferable to pointy ones that can compress and deform the natural shape of the toes. Make sure the heels don’t restrict or allow slipping inside the shoe, and opt for a wider, block heel to improve balance and improve stability.
Nobody wants to be relegated to the orthopedic shoe section or styles our grandparents wore to alleviate pain. But if we don’t take stock of what and how we wear shoes today, the consequences for tomorrow can be dramatic. There are great options that feel and look good at the same time. As I pointed out last week make sure the shoes fit properly, aren’t too worn, have great support and cushioning, a rigid heel and midsole and feel comfortable. Shoes, like anything else have to suit our own personal needs. But if your choices aren’t working talk to your healthcare provider.
-https://www.sciencedirect.com/science/article/abs/pii/S1297319X14001456
-https://www.sciencedirect.com/science/article/abs/pii/S1360859217303388
-https://www.sciencedirect.com/science/article/abs/pii/S0169814101000385
-https://www.everydayhealth.com/news/best-worst-shoes-back-pain/
-https://www.spineuniverse.com/wellness/summer-shoes-back-pain