Every Shoe Tells a Story

By Mark Charrette, DC – 

Worn-out shoes and shoes that don’t fit properly can interfere with the feet, pelvis and spine. For example, a survey on women’s shoes found 88 percent of the women surveyed were wearing shoes smaller than their feet (average 12 cm smaller). 1 Is it any wonder 80 percent of the women in the study reported “some foot pain” and 76 percent had one or more forefoot deformity? Fit Is Critical Putting your foot into a shoe is like putting it into a cast. Poor-fitting, unsupportive shoes can cause problems. When assuming a weight-bearing posture, you should be able to palpate the large toe joint and find it positioned at the widest part of the shoe. If the joint is forward of this area, the shoe is too short (you’ll seldom find the shoe is too long). As a general rule, when a shoe is ill-fitting, it is usually short and wide. Shoes that are broken down, vamps pushed over (the top of the shoe pushed laterally), with uneven heel and sole wear usually tell a story. Heel Wear Normal heel wear is slightly lateral of the midline. Heel wear should be even on both sides. If one side is worn more than another, this can indicate a weakness on that side. Usually in my practice, I find the shoe that has the most wear is on the same side as my patient’s knee, hip, or spinal problem. – 1 – Sole Wear Turn the shoe over and examine the sole wear. Start at the toe and let your eyes follow the sole wear toward the heel. At the point at which the sole wear “feathers out” and stops, draw a horizontal line with a pen or pencil. Repeat the same procedure with the opposite shoe. Determine which shoe demonstrates sole wear closest to the heel. If you find visualization difficult, measure with a ruler. When one shoe has more sole wear than the other, usually the foot pronates more – causing faster shoe breakdown and sole wear. The shoe that demonstrates the sole wear beginning closest to the heel indicates the side of greatest pronation. As a result, you may have symptoms including one or more of the following: knee pain, hip pain, lumbosacral or sacroiliac involvement, or cervical problems on that side (again, unless trauma is a factor). If the shank is breaking down excessively, purchase new shoes.

Key Points to Remember Make sure shoes fit properly; the ball of the foot should be positioned at the widest point of the shoe. Old, broken-down shoes should be thrown away immediately and replaced with new shoes. Buy shoes like you would fruit: squeeze them in the heel area. You want a firm counter around the heel to help support pronated feet. (Supinated feet need a “squishy” or soft counter.) Remove any generic insoles from shoes before inserting orthotics (if appropriate).

Reference 1. Frey C, Thompson F, et al. American orthopaedic foot and ankle society women’s shoe survey. Foot & Ankle, 1993;14:78-81.