How Do Shoes (Sandals And Heels) Affect My Feet?

One of the most common concerns that female patients have is how make sure their shoe choices are affecting their feet.  When someone is in pain, then it is our duty as physicians to do everything we can to help our patients get out of pain.  We do this with our tried and true protocols, coming up with a treatment plan for each diagnosis and help our patients complete that treatment plan.  But truth be told, our shoe choices have an influence on the condition of our feet. 

Flip flops – As summer is approaching, it would be great to be able to live in flip flops!  And to be honest with you, this keeps our doctors at Prairie Path Foot and Ankle busy because of all the detriment it may cause. 

It is so easy to wear them, and convenient going from the pool to indoors.  They tend to keep feet cool and less moisture buildup that closed shoes can cause.  In addition, you would limit the formation of corns on the tops of the toes as there is no pressure on the toes. However, due to a very flimsy strap that only fits between the toes, this causes you foot to grip the shoe tighter, aggravating the tendons on the top of your feet and in turn aggravating hammer toes if you have them.  In addition, most flip flops lack an arch support, which can aggravate heel pain as you go through the gait cycle as the foot flattens out. So it is important not to walk long distances in these unsupportive shoes, or you are welcoming a host of strains and pains in your feet.   The material they are usually made of can also cause blisters on the bottom of the feet, or between the big toe and the 2nd toe where the strap falls.  Although tempting to wear them all the time outside, it is also important to note that flip flops should not be worn while doing yard work – decrease the hazards of injuries to the open toes by wearing closed toed shoes of gym shoes for this type of work! If you insist on wearing flip flops, these are characteristics to look for: 1. Look for an arch support 2. Look for a deep heel cup 3. Look for a cushioning material that will not cause blisters on the bottom of the feet.

Birkenstocks – These sandals are not comfortable for everyone; it seems that you need to have a certain foot type for these to be preferred.  Some people find them extremely comfortable as the foot bed is made of cork, a very forgiving and comfortable sole that decreases shock absorption from walking.  The footbed does have a contoured arch and some padding in the forefoot under the metatarsal heads and these all lead to more comfort.  However, one size does not fit all, and one shoe type definitely does not fit all!  For example, if you toes are too long, they may hit the edge and maybe even go over the edge of the shoe.  A person with a very slender/narrow foot will not be able to tighten the shoe enough on the forefoot, and this could lead to slippage and instability.  In addition, patients with an arch that is too high may not feel enough support, while patients with an arch that is too low may feel undue pressure on the arch that can feel uncomfortable.  If Berkenstocks feel comfortable, then have at it, as they are a good alternative to flip flops without support. 

Slipper flats/Ballet Flats – although they are very easy to slip on and off and do look cute with an outfit, flats are not ideal for your feet.  Due to the lack of arch support in these flats, these shoes can aggravate and even cause plantar fasciitis or arch pain.  The foot flattens out, pulling the plantar fascia, and causing pain at the bottom of the heel at the plantar fascia tissue insertion.  In addition, the flat shoe may cause aggravation at the back of the heel, at the insertion of the Achilles tendon causing tightness or an Achilles tendinitis.  Make sure the shoes are also made of a breathable material, as women tend to wear these flats without socks, causing sweat to accumulate against the skin.  Increase moisture in the area can lead to fungus on the skin leading to athlete’s foot, or even blisters due to the buildup of friction against the shoe. A solution can be to wear orthotics in the flat shoes, this will give support to the arch and heel and prevent some of those aches and pains.  The doctors at Prairie Path Foot and Ankle Clinic can give you some guidance on acquiring orthotics.

High Heels – In general, as we all know, high heels are bad for your feet, (but sometimes look so good with an outfit!)  They promote a position of weightbearing where the majority of the weight is on the ball of the foot.  At the end of the metatarsals, or the long bones of the foot, the toe joint connects and puts undue pressure here that can cause a capsulitis, or inflammation of the joint where the toe attaches to the foot.  In addition, there area 2 small bones, called sesamoid bones, that are “floating bones” within a tendon that run along the bottom of the big toe.  High heels can cause undue pressure on these bones, causing a sesamoiditis (inflammation of the sesamoid bones) that will cause pain under the big toe joint.  High heels also put undue pressure on all the metatarsal bones, which over time and repetitive stress can cause a stress fracture of the metatarsal bones.  As the position of the foot causes the heel to be positioned higher than rest of the foot, causing contraction at the Achilles tendon.  This tightness can lead to Achilles tendinitis, or pain in the back of the heel at the Achilles tendon. 

Some heels that are tight around the back of the heel where the Achilles tendon inserts can cause a “pump bump” or a calcification of the tendon or bone growth that may cause a palpable bump that an be painful with shoes. In addition, the high stiletto heels leave an unsteady base and can be a risk factor for sprained ankles.  And watch out for those pointed toes on the heels!  A pointed toebox can aggravate a bunion as the shoe presses against the side of the foot and base of the big toe. The solution?  1. Use a lower heel, maybe no more than 2 inches off the ground 2.  Wear a “chunky” heel that will help distribute the weight more evenly and 3. Use a platform heel that will give you height, but will avoid the excessive dorsiflexion of the toes onto the metatarsals with a more even lift throughout the bottom of the foot and 4. Choose a shoe with a wide toe box that won’t aggravate your toes!

Whichever shoes you choose, be sure to choose wisely. And if you have aches and pains from shoes or any other aches and pains in your feet, remember that foot pain is never normal.  Make an appointment with one of our doctors for a full evaluation to get some relief.