When I meet with a new patient, the first thing I look at is the way the person walks and their shoes. The ways the shoe connects to the shape of someone’s foot has everything to do with the corns, callouses, and the irritations and even pain and discomfort that I will find when I examine their feet. A foot care session becomes a lesson about choice and fit and begins an investigation into how shoe choice impacts the body. This is insider shoe knowledge people benefit from knowing but seldom receive.
Gone are the days of the expert shoe fitter. With so many choices available, too many people leave a shoe store in mild discomfort, hoping to “break in” their new shoes over time. They pinch the end of the shoe, find some toe space, and assume the shoes fit. Or they order online and keep shoes that don’t feel quite right because it’s a chore to send them back. Too often, people think going up a size will fix the problem, but this ignores foot volume and shape and can result in feet slipping around in shoes that are too big. Even shoes that come in widths may still not fit properly if the widest part of the shoe does not match the widest part of the foot. Many of my patients have a closet filled with shoes that are rarely worn because they never felt quite right.
When I meet with a new patient, the first thing I look at is the way the person walks and their shoes.
When there is slippage or rubbing, the shoe may not be properly secured or may not actually fit. If toes are clenched or pointed upwards, as they do when they are trying to keep a too-large shoe on, there’s often foot pain, and an altered gait. Also, when toes cannot wiggle freely, they cannot do their part in balance. Each tiny toe is loaded with thousands of nerve receptors that feed the brain information to help us adjust to uneven terrain. A stiffened foot does not function well.
We wear shoes for protection, fashion, and activities. We buy them without realizing that some features may not be compatible with our needs. For instance, many sneakers and walking shoes offer quite a bit of cushioning to absorb impact. We live in a hard-paved world, so that makes sense, but there is another side. Feet are designed to move and respond to the environment. To the body, walking on air-filled shoes is like trying to walk on a mattress. It’s hard work and not the way the body is supposed to move. Some boots are stiff and promise support, but when the foot cannot move, the foot muscles become weak. Weak, wobbly feet lead to loss of balance, falls, and knee and hip pain.
One person’s favorite shoe can be another person’s problem. A fit runner will swear by a pair of sneakers and suggest them for an older adult, not realizing that the science of foot health for older adults suggests a thinner sole which allows for contact, not disconnection. This is important because older adults often have sensory deprivation (hearing, sight, feeling) and depriving them of more contact is not an optimal choice.
Shoes and shoe choice push up against marketing and fashion so at the very least it’s complicated, and there is no solution that works for everyone, except for education. A trained foot care nurse can educate about evaluating fit. I start by pulling out the insole of a patient’s shoe and holding it against the bottom of my patient’s foot. Whether or not the shapes match becomes immediately clear. Deep indentations in the toe area indicate that the toes are curling downwards to hold a shoe not secured well. Gripping equals tension that can spread throughout the body. Tension negatively influences circulation, blood pressure, and well-being. In a tense body, energy cannot flow, legs and feet stiffen, and a life-changing fall becomes more probable.
People can check for shoe shape compatibility when they are shopping. Pulling out the insole and comparing it to the pattern of your foot can be easily done; or spend a few minutes at home tracing the outline of the foot, cut it out, and bring it to the store. Holding this pattern against a shoe on display will immediately tell you if the shapes conform. A caregiver shopping for someone who does not go out can bring this outline to the shoe store to be sure that the purchase is a “good fit.”
Once the proper shoe selection is made, fastening the shoe is the next challenge. Slip-on shoes are popular now, especially among people who have trouble reaching their feet, but they will never be as secure as a shoe that is laced correctly. There are thousands of ways to tie a shoe, but people are taught just one when they learn to tie their shoes. Often changing the lacing pattern just a little can result in more security. Patients at FootCare by Nurses are often surprised by this small change.
For me, the most important part of my work is the educational component. Most patients are delighted to have new knowledge that can enhance their quality of life and help prevent foot-related pain and falls. Unlike podiatrists who tend to focus on medical interventions, foot care nurses have many tools that focus on prevention and understanding.
I hope that readers will feel compelled to take off their shoes and inspect the insoles to see what they reveal. This is something caregivers can do as well. And while your shoes are off, spend a few moments stretching and massaging those feet and enjoy the sensations. I can promise that proactive application of pattern fit and securement will prevent many ailments including foot, knee, hip, and back pain while also saving you money. At the very least the shoes you purchase (even at the thrift store) will be far more comfortable and will not end up in the back of the closet.
