Simple Recommendations For Shoe Fitting
Leonardo da Vinci once said, “The human foot is a masterpiece of engineering, and a work of art.” 26 bones, 33 joints, and over 100 ligaments and tendons allow the foot to be mobile enough to absorb the impact with the ground, adaptable enough to maximize balance on uneven surfaces, and rigid enough when needed for push off mechanics.
Given the complexity that is our feet, and the variety of options available for shoe wear, it is easy to understand why getting the right pair of shoes can be such a frustrating and time consuming activity for so many people, and it is a frequent topic of conversation when patients arrive for their initial or follow up visits.
According to the Academy of Orthopedic Surgeons, more than 43 million Americans, or one in every six people, develop a significant foot injury over the course of their life that results in costs exceeding $3.5 Billion per year. In addition, it is estimated that greater than 80% of women and 60% of men are routinely wearing ill fitting shoes. Given that over the course of a lifetime, the average person will purchase between 450-600 pairs of shoes, good decision making when shoe shopping is critical.
Here is a list of the most common recommendations:
Fit Shoes in the Afternoon or Evening
Feet can swell and spread over the course of a normal day, changing its overall shape. This makes late afternoon or evening an ideal time to assess the fit of your foot in a particular shoe.
Measure Both Feet While Standing
75% of people that are right handed have a larger left foot. Using a Brannock measuring device, stand in a 1/2 squat to measure the length and width of each foot independently. When you walk, as your heel lifts off the ground, the forefoot spreads and adapts to the surface you are standing on to provide optimal balance. A shoe should not interfere with your foot’s natural mechanics, and will allow for a more efficient stride, and less need for compensation.
Fit For Comfort
The literature indicates that the most important factor in selecting a shoe should be focused on how they feel when they first put the shoes on. A shoe that does not feel good initially, will never magically feel good later, regardless of the marketing, or cost, or reputation it has.
Alignment of Knee
With both shoes on, perform a 1/2 squat. In this position the bottom most point of the knee cap should align with the space between the first and second toe. If you want to be “high tech” about it try using a laser pointer to easily visualize this (see video). If the alignment is to the inside of the big toe, then the shoe might be too soft. If the alignment is to the outside of the second toe, the shoe might be too rigid. These deviations can be due to weak foot musculature and not always as a result of structural problems, but this is a discussion for a different blog.
Pronation / Supination
With both shoes on and in a 1/2 squat position, twist from side to side. The shoe should always allow for both pronation and supination (rolling of the foot and ankle in and out) to occur as they are both important to proper foot mechanics (see video)
It is important to remember that buying new shoes as a strategy for treating pain is not a good long-term solution, but it can be part of a multi-facetted approach that includes proper assessment with an accurate diagnosis of the underlying problem. In addition, these recommendations do not substitute the need for a knowledgeable shoe salesperson that understands the inventory available and the inherent characteristics of each shoe model. All of these are essential to a complete, long-lasting recovery.
