One of the most common questions I receive from my patients, particularly those dealing with lower extremity or lumbo-pelvic injuries, is what type of footwear they should be wearing. While footwear is certainly a piece of the injury prevention and rehabilitation spectrum, I do tend to caution people that it is a smaller portion of the equation than it is sometimes made out to be. Though choosing proper footwear can assist in minimizing joint impact forces, or improving alignment / joint positioning, it is not a magic wand that will make injuries vanish at the end of the day (and trust me, some people think it is). With all that being said, here are some very brief, general thoughts regarding footwear.
Important considerations: age, job requirements, foot type, personal comfort
1.) Age: This is fairly basic in nature. Typically, anyone under the age of 70 and in good health, I will give free reign to use whatever type of footwear fits their daily aesthetic or functional needs. For those older than 70, I think we need to begin to consider safety and balance capabilities in more depth. Obviously this will vary on a case by case nature. I recommend that my elderly patients where a flat bottomed, structured and supportive shoe with a stiff heel counter, supportive midfoot, and mildly flexible toe box. High heels and flip flops are a recipe for falls and injuries. You should feel confident and comfortable in your footwear. IF you in anyway feel unsteady when first wearing them, they’re not the right shoe for you, there are better options out there.
2.) Job requirements: Again, this is mostly common sense, but I’ve certainly seen people mess it up. Obviously certain jobs will require different types of footwear, either for stylistic or functional requirements. A few quick takeaways based on my experience:
- blue-collar, steel toe boot wearers should consider adding an over the counter cushioning insert to minimize joint impact and wear / tear throughout the day. Most boots are very supportive, but not highly cushioned to absorb stresses
- high heel or rigid dress shoe wearers should utilize comfortable sneakers if they have a prolonged standing or walking commute
- people on their feet for long hours (hospitality, healthcare workers) need the right combination of support and cushioning
3.) Foot type
- Flat / pronated feet – need a supportive midfoot and a rigid medial heel counter – sometimes the right type of shoe is enough to correct the deformity without additional inserts or orthotics, however I will recommend to my more severe cases that they may want to consider adding a supportive insert to their normal footwear. Over the counter has been shown to be just as effective as custom inserts in most cases, but if that cheaper option proves ineffective, I will send patients to an orthotist for further evaluation.
- High arch / supinated feet – cushioning, cushioning, cushioning. Rigid, supinated feet don’t absorb ground reaction forces well, thereby transferring them further up the chain to the knees / hips / lumbo-pelvic region. Supinated feet can also be prone to lateral ankle sprains, so some support through the heel, particularly laterally, is beneficial.
Finally, I just wanted to briefly touch upon the hot button topic in footwear, or lack thereof, over the past 5-10years: barefoot or minimalist. While the benefits to balance and foot / ankle strength are undeniable, I find that this type of approach is not appropriate for the vast majority of people. I think in order to properly use this method with minimal risk of injury, people need to check off three boxes: neutral foot and ankle alignment, good running mechanics, and excellent hip / core control. If they’re lacking in any of those three aspects, this is not the right answer for you, and you will likely create a problem elsewhere. Just a word of caution regarding that popular topic. Hope this basic overview helps!