"After my athletic injury, I had met with several doctors in the Northern Virginia area… many were quick to diagnose, quick to jump into surgery, and quick to misdiagnose. Dr. Pontell not only examined my foot via MRI, Xray, Ultrasound and in person – he explained EVERYTHING to me... After completely healing, at 38 years old I can run longer, and run faster than I ever had been able to run before – even before my injury. I’m in the best shape of my life. I tell everyone all the time that I am able to do what I do because of him - my foot he reconstructed is a million times stronger than my uninjured foot." -A.D.
"I went to Dr. Hallivis based on his reputation and his extensive experience. He definitely stood up to his reputation. He was professional, friendly, approachable and knew everything there was to know about my problem. He treated me and my pain resolved in 2 days. His office ran on time and his staff was warm and helpful. I would recommend him to anyone with a foot problem.” - M.H.
Understanding the basic construction of shoes will help you make more informed decisions and select shoes that fit your foot and needs.
Shoes are made up of five major components:
- The toe box is the tip of the shoe that provides space for the toes. Toe boxes are generally rounded, pointed, or squared and will determine the amount of space provided for the toes.
- The vamp is the upper middle part of the shoe where the laces are commonly placed. Sometimes Velcro is used instead of laces.
- The sole consists of an insole and an outsole. The insole is inside the shoe; the outsole contacts the ground. The softer the sole, the greater the shoe’s ability to absorb shock.
- The heel is the bottom part of the rear of the shoe that provides elevation. The higher the heel, the greater the pressure on the front of the foot.
- The last is the part of the shoe that curves in slightly near the arch of the foot to conform to the average foot shape. This curve enables you to tell the right shoe from the left.
The material from which a shoe is made can affect fit and comfort. Softer materials decrease the amount of pressure the shoe places on the foot. Stiff materials can cause blisters. A counter may be used to stiffen the material around the heel and give added support to the foot.
Athletic Shoe Guidelines
Athletic footwear should be fitted to hold the foot in the position that’s most natural to the movement involved. Athletic shoes protect your feet from stresses encountered in a given sport and to give the player more traction. The differences in design and variations in material, weight, lacing characteristics, and other factors among athletic shoes are meant to protect the areas of the feet that encounter the most stress.
Well-fitted athletic shoes need to be comfortable, yet well-constructed and appropriate for a given activity. A good fit will mitigate blisters and other skin irritations.
Sports-specific athletic shoes are a good investment for serious athletes, though perhaps a less critical consideration for non-athletes. Don’t wear any sport or other shoes beyond their useful life.
A running shoe is built to take impact, while a tennis shoe is made to give relatively more support, and permit sudden stops and turns. Cross training shoes are fine for a general athletic shoe, such as for physical education classes or health club exercising, such as on stair machines and weight-lifting because they provide more lateral support and less flexibility than running shoes. They also tend to be heavier than running shoes, but most people don’t need light, flexible shoes for cross-training. If a child is involved more heavily in any single sport, he or she should wear shoes specifically designed for that sport.
Our practice recommends sturdy, properly fitted athletic shoes of proper width with leather or canvas uppers, soles that are flexible (but only at the ball of the foot), cushioning, arch supports, and room for your toes. Try a well-cushioned sock for reinforcement, preferably one with acrylic fiber content so that some perspiration moisture is “wicked” away.
Athletic shoes need to be replaced after one year, whether or not they are worn, and after a certain amount of repetitive load is placed on them and wears them down. The American Academy of Podiatric Sports Medicine advises replacing running or walking shoes after 300 to 500 miles of wear, and replacing aerobic, basketball, and tennis shoes after 45 to 60 hours of wear. Athletic shoes should also be replaced if they show signs of unevenness when placed on a flat surface, display noticeable creasing, and/or when the heel counter breaks down.
Choosing shoes for your children can play a critical role in their musculoskeletal development, including their posture.
In general, infants just learning to walk do not need shoes. Infants may go barefooted indoors, or wear only a pair of socks. This helps the foot grow normally and develop its muscles and strength as well as encourages the grasping ability of toes.
Once children are ready to walk as toddlers, their need for properly-fitted shoes is important. In general, a soft, pliable, roomy shoe, such as a sneaker, is ideal for all children. The toe box should provide enough space for growth and should be wide enough to allow the toes to wiggle. A finger’s breadth of extra length will usually allow for about three to six months’ worth of growth, though this can vary depending on your child’s age and rate of growth.
Because high-top shoes tie above the ankle, they are recommended for younger children who may have trouble keeping their shoes on. Contrary to common belief, however, high-top shoes offer no advantages in terms of foot or ankle support over their low-cut counterparts.
Here are some tips when purchasing shoes for children:
- Both feet should be measured every time you shop for new shoes since those little feet are growing. If, as is common, the feet are two different sizes, shoes should be fitted to the larger foot.
- The child’s foot should be sized while he or she is standing up with full weight-bearing.
- There should be about one-half inch of space (or a thumb’s width) between the tip of the toes and the end of the shoe. The child should be able to comfortably wiggle his or her toes in the shoe.
- Have the child walk around the store for more than just a few minutes wearing the shoe with a normal sock. Ask the child if he or she feels any pressure spots in the shoe. Look for signs of irritation on the foot after the shoe is tested.
- Put your hand inside the shoe and feel around for any staples or irregularities in the glue that could cause irritation. Examine where the inside stitching hits the foot.
- Examine the shoe itself. It should have a firm heel counter (stiff material on either side of the heel), adequate cushioning of the insole, and a built-in arch. It should be flexible enough to bend where the foot bends at the ball of the foot, not in the middle of the shoe.
- Never try to force your child’s feet to fit a pair of shoes.
- Shoes should not slip off at the heels. Children who have a tendency to sprain their ankles will do better with high-top shoes or boots.
Children who frequently remove shoes from their feet may be signaling some discomfort. Check your child’s feet periodically for signs of too-tight shoes, such as redness, calluses or blisters, which will help you know when they’ve outgrown their shoes.
Remember that the primary purpose of shoes is to prevent injury. Shoes seldom correct children’s foot deformities or change a foot’s growth pattern. Casting, bracing, or surgery may be needed if a serious deformity is present. If you notice a problem, please contact our office to have your child’s feet examined.
Corrective and Prescription Shoes
Proper footwear is an important part of an overall treatment program for people with diabetes, even at the earliest stages of the disease. If there is any evidence of neuropathy, wearing the right footwear is crucial.
As a general rule, people with diabetes should choose shoes that:
- Accommodate, stabilize, and support deformities, such as Charcot Foot, loss of fatty tissue, hammertoes, and amputations. Many deformities need to be stabilized to relieve pain and avoid further damage. In addition, some deformities may need to be controlled or supported to decrease further progression of the deformity.
- Limit motion of joints. Limiting the motion of certain joints in the foot can decrease inflammation, relieve pain, and result in a more stable and functional foot.
- Reduce shock and shear. A reduction in the overall amount of vertical pressure, or shock, on the bottom of the foot is desirable, as well as a reduction of horizontal movement of the foot within the shoe, or shear.
- Relieve areas of excessive pressure. Any area where there is excessive pressure on the foot can lead to skin breakdown or ulcers. Footwear should help to relieve these high-pressure areas, and therefore reduce the occurrence of related problems.
Many diabetics need special prescription footwear. The various types include:
- Custom-made shoes. When extremely severe deformities are present, a custom-made shoe can be constructed from a cast or model of the patient’s foot. With extensive modifications of in-depth shoes, even the most severe deformities can usually be accommodated.
- External shoe modifications. In these cases, the outside of the shoe is modified in some way, such as adjusting the shape of the sole or adding shock-absorbing or stabilizing materials.
- Healing shoes. Immediately following surgery or ulcer treatment, special shoes may be necessary before a regular shoe can be worn. These include custom sandals (open toe), heat-moldable healing shoes (closed toe), and post-operative shoes.
- In-depth shoes. An in-depth shoe is the basis for most footwear prescriptions. It is generally an oxford-type or athletic shoe with an additional 1/4-inch to 1/2-inch of depth throughout the shoe. This extra volume accommodates inserts, or orthotics, as well as deformities commonly associated with a diabetic foot. In-depth shoes are usually designed to be light in weight, have shock-absorbing soles, and come in a wide range of shapes and sizes to accommodate virtually any foot.
- Orthoses or shoe inserts. Also known as orthotics, an orthosis is a removable insole which provides pressure relief and shock absorption. Both pre-made and custom-made orthotics or shoe inserts are commonly recommended for patients with diabetes, including a special total contact orthosis, which is made from a model of the patient’s foot and offers a high level of comfort and pressure relief.
What to Look For
- Avoid shoes that have seams over areas of pain, such as a bunion.
- Avoid shoes with heavy rubber soles that curl over the top of the toe area (such as seen on some running shoes), because they can catch on carpets and cause an accidental fall.
- Flat shoes (with a heel height of one inch or less) are the healthiest shoes for your feet. If you must wear a high heel, keep to a heel height of two inches or less, limit their wear to three hours at a time, and take them off coming to and from an activity.
- Laced, rather than slip-on shoes, provide a more secure fit and can better accommodate insoles, orthotic devices, and braces.
- Look for soles that are shock absorbing and skid resistant, such as rubber, rather than smooth leather.
- Shoes should be made of a soft material that has some give.
Getting a Proper Fit
Everything from serious foot disorders to more common foot and ankle conditions can be exacerbated by one, avoidable cause: inappropriate, poor quality, and/or ill-fitting shoes. Any podiatrist will tell you that a quality, properly fitted shoe pays big dividends for your feet—now and in the future.
The most important quality to look for in shoes durable in construction that will protect your feet and keep them comfortable. Shoes that do not fit properly can cause bunions, corns, calluses, hammertoes and other disabling foot disorders.
Here are some tips to help reduce the risk of foot problems when shopping for shoes:
- Don’t force your feet into a pair of shoes in order to conform to the shape of the shoe. The shoe needs to conform to the shape of your foot.
- Fit new shoes to your largest foot. Most people have one foot larger than the other.
- Have both feet measured every time you purchase shoes. Foot size increases as you get older.
- If the shoes feel too tight, don’t buy them. There is no such thing as a “break-in period.”
- Many high-heeled shoes have a pointed or narrow toe box that crowds the toes and forces them into an unnatural triangular shape. As heel height increases, the pressure under the ball of the foot may double, placing greater pressure on the forefoot as it is forced into the pointed toe box. Limit heel height to two inches or less to protect your feet.
- Shoes should be fitted carefully to your heel as well as your toes.
- Sizes vary among shoe brands and styles. Judge a shoe by how it fits on your foot, not by the marked size.
- There should be a half-inch of space from the end of your longest toe to the end of the shoe.
- Try on new shoes at the end of the day. Your feet normally swell and become larger after standing or sitting during the day, which makes for a better fit.
- Be sure to try on both shoes. Walk around the shoe store in the shoes to make sure they fit well and feel comfortable.
- When the shoe is on your foot, you should be able to freely wiggle all of your toes.
Most men’s shoes conform to the shape of the feet and have a roomy toe box with sufficient horizontal and vertical space and a low heel (usually about half an inch high). Soles made of either hard materials (such as leather) or soft materials (such as crepe) can be worn, but softer soles tend to be more comfortable. If you stand for extended periods of time, shoes with soft, pliable and cushioned soles will protect your feet and help keep them comfortable.
The best shoes for men are good quality oxford styles, shoes ordinarily associated with wing-tip or cap toe designs. Also suitable are slip-ons, dressy loafers, and low dress boots.
It is advisable to have three to five pairs of shoes for business so that you can alternate your shoes on a daily basis.
The best shoe for women’s feet is a walking shoe with laces (not a slip-on), a composition sole, and a relatively wider heel with a rigid and padded heel counter, no more than three-quarters of an inch in height.
Some women inflict punishment on their feet from improper footwear that can bring about unnecessary foot problems. Some of the problems result from high-heeled shoes (generally defined as pumps with heels of more than two inches).
A study conducted by the American Orthopaedic Foot and Ankle Society found that:
- Nine out of 10 women wear shoes that are too small for their feet.
- Eight out of 10 women say their shoes are painful.
- More than 7 out of 10 women have developed a bunion, hammertoe, or other painful foot deformity.
- Women are nine times more likely to develop a foot problem because of improper fitting shoes than a man.
- Nine out of 10 women’s foot deformities can be attributed to tight shoes.
High-heeled, pointed-toe shoes can cause numerous orthopedic problems, leading to discomfort or injury to the toes, ankles, knees, calves, and back. Many high-heeled-shoes also have a pointed, narrow toe box that crowds the toes and forces them into an unnatural triangular shape. These shoes distribute the body’s weight unevenly, placing excess stress on the ball of the foot and on the forefoot. This uneven distribution of weight, coupled with the narrow toe box characteristic of most high heels, can lead to discomfort, bunions, hammertoes, and other deformities.
The height of the heel makes a dramatic difference in the pressure that occurs on the bottom of the foot. As heel height increases, the pressure under the ball of the foot may double, placing greater pressure on the forefoot as it is forced into the pointed toe box.
To relieve the abusive effects of high heels, women should limit the amount of time they wear them and alternate these shoes with good quality sneakers or flats for part of the day. Look for comfortable and attractive walking pumps for work and social activities, that blend fashion appeal with athletic shoe-derived construction, reinforced heels, and wider toe room for greater comfort. Low-heeled shoes (one inch or lower) with a wide toe box are the ideal choice for women. An ample toe box that can accommodate the front part of the foot is as important as the heel in determining fit.
When you take a step, your foot typically hits the ground heel first and rolls toward your toes, flattening the arch slightly. As you push off the ball of your foot, your arch springs back and does not touch the ground. That’s how normal feet are supposed to work. Unfortunately, many feet aren’t normal.
Overpronation occurs if your foot rolls too much toward the inside. This can cause arch strain and pain on the inside of the knee. Underpronation occurs if your foot rolls too much to the outside. Underpronation can lead to ankle sprains and stress fractures. You can relieve foot pain by compensating for these tendencies, but first, you need to determine which way your feet roll.
One method for determining which kind of pronation you have is the watermark test: Put your feet into a bucket of water, then make footprints on a piece of dark paper.
- If your footprint looks like an oblong pancake with toes, you pronate excessively or may have flat feet. Try molded-leather arch supports, which can be purchased in many drug stores. And when shopping for athletic shoes, ask a sales clerk for styles with “control” features—soles designed to halt the rolling-in motion. If arch supports or sports shoes don’t help, please contact our office for a custom-molded orthotics.
- If there’s little or no connection in your footprint between the front part of the foot and the heel, you under-pronate or have a high arch. This means a lot of your weight is landing on the outside edge of your foot. Ask for “stability” athletic shoes, which are built with extra cushioning to remedy this problem. If you are prone to ankle sprains, wear high-top athletic shoes that cover the foot and ankle snugly to minimize damage from twists.
Examining old shoes before buying new ones can help you evaluate your wear patterns and buy new shoes with a better fit and style that compensates for the stresses you place on shoes.
What are your shoes trying to tell you? Here is a translation of basic wear patterns:
- A bulge and wear to the side of the big toe means too-narrow fit or you have a bunion.
- Outer sole wear means you turn your foot out. Orthotics may help.
- Toe-shaped ridges on the upper means your shoes are too small or you have hammertoes.
- Wear on the ball of the foot means your heel tendons may be too tight.
- Wear on the inner sole means you pronate or turn your foot inward. Inner liners or orthotics may help.
- Wear on the upper, above the toes means the front of your shoe is too low.