The sole of the shoe is also a major consideration. I find I have a number of people coming in with foot problems, generally on the bottom of the foot, that is due to the sole either being too stiff, or too flexible. Said another way, the sole should be able to bend, but not excessively.

When standing barefoot, roughly 50 percent of body weight rests on the heel, and the other 50 percent on the ball of the foot. When you then put the foot into a shoe, the higher the heel on the shoe, the greater the portion of body weight that distributes to the ball of the foot, and therefore away from the heel. Consequently, a lower heel gives better weight distribution. Excess weight distribution is also a source of foot pain, primarily forefoot pain.

One way to counter the unequal distribution, is through an arch support (orthotic). It picks up some of the body weight in the midfoot, and reduces the pressure on the heel and ball of the foot. For those of you who already wear orthotics, you well know that they require a closed shoe, so what happens when you want to wear a sandal and your orthotics will not fit? The solution is to wear a sandal or slipper that has a built in orthotic, or at least some shock absorbency (cushioning).

Since the biggest cause of foot problems is pronation (feet rolling inward), a sandal that forces the foot out of pronation may be the answer, to allow you to go without your orthotics, and still be comfortable.

From an anatomy point of view, women tend to have narrower feet than men. But women are constantly complaining about the inability to find shoes that “stay on”. Should a woman develop a general bunion, or tailor’s bunion (bunionette), this further widens the forefoot, relative to the rearfoot, and makes it even harder to find shoes.

When shopping for shoes, most people make the mistake and look for a shoe in one size. Your feet should always be measured at the time of purchase. As well, you should try to purchase your shoes at the end of the day, when the feet are most swollen. A shoe that is uncomfortable at 8:00 a.m. may be very uncomfortable by 8:00 p.m. Secondly, in this day and age, shoes are made all over the world, and do not all correspond to American sizes. If you look closely at the shoes or their boxes, particularly the athletic ones, you will see that they are listed in multiple sizes; American, European, etc. So, buy the shoe according to the criteria of how it fits, not by the shoe size number written on the box.

Many times during the course of conversation,  a patient will show me that their shoe is worn out in the wrong area of the heel. They point to the wear on the posterior-outside of the heel, thinking that normal heel wear is directly on the back. This is not the case. We walk with one foot in front of the other, relative to the mid line of the body; so normal heel strike is on the posterior-outside of the shoe. Excessive heel wear on the back, or even the posterior-inside of the heel, is a sign of excessive pronation.

As a final thought, although I have no hard statistics, I would say the biggest cause of foot or leg pain, is from wearing inappropriate shoes, and more so, shoes that have worn out. It amazes me how many times I have had to tell patients to change their footwear, and their problem would disappear. Shoes are designed to afford the foot certain protection. Once the shoe has worn out, the protection is lost, and inevitably pain kicks in.

Today is Boxing Day, and so the limes are in high swing, do enjoy… but I’m appealing to the fashionistas to think about your feet, when choosing your footwear. Happy Holidays to all!

Your feet mirror your general health . . . cherish them!