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Facts About Shoes

Poorly fitting shoes can cause bunions, corns, calluses, hammertoes, and other disabling foot problems.

According to the American Academy of Orthopedic Surgeons, one in six persons or 43.1 million people in the U.S. have foot problems. Thirty-six percent regard their foot problems as serious enough to warrant medical attention.

The cost of foot surgery to correct foot problems from tight-fitting shoes is $2 billion a year, according to the AAOS. If time off from work for the surgery and recovery is included, the cost is $3.5 billion.

General Tips

General Tips About Shoe Features/Selection

Some serious foot disorders, and even more common conditions, can be linked to one avoidable thing: inappropriate, poor quality or ill-fitting shoes. Any podiatrist will tell you that a good quality, properly fitting shoe pays big dividends for your feet down the road.

When shopping for shoes, always make sure to not force your feet in order to conform to the shape of a pair of shoes.

The most important quality to look for in shoes is durable construction that will protect your feet and keep them comfortable. Shoes that do not fit properly can cause bunions, corns, calluses, hammertoes and other disabling foot disorders.

The fitting

Here are some tips to help reduce the risk of foot problems. Use this guide when you shop for shoes:

  • Fit new shoes to your largest foot. Most people have one foot larger than the other.
  • Have both feet measured every time you purchase shoes. Your foot size increases as you get older.
  • If the shoes feel too tight, don't buy them. There is no such thing as a "break-in period."
  • Most high heeled-shoes have a pointed or narrow toe box that crowds the toes and forces them into an unnatural triangular shape. As heel height increases, the pressure under the ball of the foot may double, placing greater pressure on the forefoot as it is forced into the pointed toe box.
  • Shoes should be fitted carefully to your heel as well as your toes.
  • Sizes vary among shoe brands and styles. Judge a shoe by how it fits on your foot - not by the marked size.
  • There should be a half-inch of space from the end of your longest toe to the end of the shoe.
  • Try on both shoes.
  • Try on new shoes at the end of the day. Your feet normally swell and become larger after standing or sitting during the day.
  • Walk around in the shoes to make sure they fit well and feel comfortable.
  • When the shoe is on your foot, you should be able to freely wiggle all of your toes.
  • Women should not wear a shoe with a heel higher than 2 1/4 inches.

Anatomy of a Shoe

A shoe has many different components. If you understand basic shoe construction, you can make a more informed decision from among the thousands of available styles.

The toe box is the tip of the shoe that provides space for the toes. Toe boxes are either rounded or pointed and will determine the amount of space provided for the toes.

The vamp is the upper middle part of the shoe where the laces are commonly placed. Sometimes Velcro is used instead of laces.

The sole consists of an insole and an outsole. The insole is inside the shoe; the outsole contacts the ground. The softer the sole, the greater the shoe's ability to absorb shock.

The heel is the bottom part of the rear of the shoe that provides elevation. The higher the heel, the greater the pressure on the front of the foot.

The last is the part of the shoe that curves in slightly near the arch of the foot to conform to the average foot shape. This curve enables you to tell the right shoe from the left.

The material from which the shoe is made can affect fit and comfort. Softer materials decrease the amount of pressure the shoe places on the foot. Stiff materials can cause blisters. A counter may be used to stiffen the material around the heel and give support to the foot.

What to Look For

  • Avoid shoes that have seams over areas of pain, such as a bunion.
  • Avoid shoes with heavy rubber soles that curl over the top of the toe area (such as seen on some running shoes), as they can catch on carpets and cause an accidental fall.
  • Flat shoes (with a heel height of one inch or less) are the healthiest shoes for your feet. If you must wear a high heel, keep to a heel height of two inches or less, limit them to three hours at a time and take them off coming to and from an activity.
  • Laced, rather than slip-on shoes, provide a more secure fit and can accommodate insoles, orthotic devices and braces.
  • Look for soles that are shock absorbing and skid resistant, such as rubber rather than smooth leather.
  • The shoe should be made of a soft material that has some give, like glove leathers.

Your Footprint

When you take a step, your foot typically hits the ground heel first and rolls toward your toes, flattening the arch slightly. As you push off the ball of your foot, your arch springs back and does not touch the ground. That's how normal feet are supposed to work. Unfortunately, many feet aren't normal.

Over-pronation occurs if your foot rolls too much toward the inside. This can cause arch strain and pain on the inside of the knee. Under-pronation occurs if your foot rolls too much to the outside; under-pronation can often lead to ankle sprains and stress fractures. You can relieve foot pain by compensating for these tendencies, but first you need to determine which way your feet roll.

One method for determining which kind of pronation you have is the watermark test: Put your feet into a bucket of water, then make footprints on a piece of dark paper. If your footprint looks like an oblong pancake with toes, you pronate excessively or have flat feet. Try molded-leather arch supports, which can be purchased in many drug stores. And when shopping for athletic shoes, ask a sales clerk for styles with "control" features - soles designed to halt that rolling-in motion. If arch supports or sports shoes don't help, contact our office about custom-molded orthotic shoe inserts.

If there's little or no connection in your footprint between the front part of the foot and the heel, you under-pronate or have a high arch. This means a lot of your weight is landing on the outside edge of your foot. Ask for "stability" athletic shoes, which are built with extra cushioning to remedy this problem. And if you are prone to ankle sprains, wear high-top athletic shoes that cover the foot and ankle snugly to minimize damage from twists.

Wear Patterns

Bringing in old shoes when you're buying new ones can be helpful if you have a knowledgeable salesperson. She can evaluate the wear patterns to help you get a better fit as well as a style that will compensate for the stresses you place on shoes.

What are your shoes trying to tell you? Here are the basic wear patterns:

  • A bulge and wear to the side of the big toe: A too-narrow fit or you have a bunion.
  • Outer sole wear: You turn out. Orthotics may help.
  • Toe shaped ridges on the upper: Shoes are too small or you have hammertoes.
  • Wear on the ball of the foot: Your heel tendons may be too tight. Stretch with heel raises.
  • Wear on the inner sole: You pronate or turn in. Inner liners or orthotic supports may help.
  • Wear on the upper, above the toes: The front of your shoe is too low.

Specific Types of Shoes

General Athletic Shoes

Athletic footwear should be fitted to hold the foot in the position that's most natural to the movement involved. Athletic shoes protect your feet from stresses encountered in a given sport and to give the player more traction. The differences in design and variations in material, weight, lacing characteristics and other factors among athletic shoes are meant to protect the areas of the feet that encounter the most stress.

Well-fitted athletic shoes need to be comfortable, yet well-constructed and appropriate for a given activity. A good fit will mitigate blisters and other skin irritations.

Sports-specific athletic shoes are a good investment for serious athletes, though perhaps a less critical consideration for non-athletes. Don't wear any sport or other shoes beyond their useful life.

A running shoe is built to take impact, while a tennis shoe is made to give relatively more support, and permit sudden stops and turns. For sports, "cross trainers" are fine for a general athletic shoe, such as for physical education classes. Cross-trainers, ideal for stair machines and weight-lifting, provide more lateral support and less flexibility than running shoes and may be heavier. You don't need light, flexible shoes for cross-training. But if a child is involved more heavily in any single sport, he or she should have a shoe specifically designed for that sport.

Our practice recommends sturdy, properly fitted athletic shoes of proper width, with leather or canvas uppers, soles that are flexible (but only at the ball of the foot), cushioning, arch supports, and room for your toes. Try a well-cushioned sock for reinforcement, preferably one with an acrylic fiber content so that some perspiration moisture is "wicked" away.

Soccer shoes should offer a reinforced toe, wide toebox, soft leather, field-appropriate cleats, well-padded soles and a support system that can help prevent ankle sprains and knee injuries.

Tennis shoes should provide good arch support, a reinforced toe, a roomy toe-box and a comfortable collar in the back of the shoe. If the collar is too high, it rubs against the Achilles' tendon, a problem frequently experienced by tennis players.

Basketball shoes should provide support for lateral movement and extra stability to guard against ankle sprains.

Children's Shoes

Choosing shoes for your children can play a critical role in their musculoskeletal development, including their posture in later years.

In general, infants just learning to walk do not need shoes; the child may go barefooted indoors, or wear only a pair of socks. This helps the foot grow normally and develop its muscles and strength, as well as the grasping ability of toes.

Here are some tips when purchasing shoes for children:

Both feet should be measured, and if two different sizes, shoes should be chosen that fit the larger foot best.

Examine the shoe itself. It should have a firm heel counter (stiff material on either side of the heel), adequate cushioning of the insole, and a built-in arch. It should be flexible enough to bend where the foot bends at the ball of the foot, not in the middle of the shoe.

Have the child walk around the store for more than just a few minutes wearing the shoe with a normal sock. Ask the child if he or she feels any pressure spots in the shoe. Feel the inside of the shoe for any staples or irregularities in the glue that could cause irritation. Examine where the inside stitching hits the foot. Look for signs of irritation on the foot after the shoe is worn.

Never try to force your child's feet to fit a pair of shoes.

Shoes should not slip off at the heels. Children who tend to sprain their ankles will do better with high-top shoes or boots.

The child's foot should be sized while he or she is standing up with full weight-bearing.

There should be about one-half inch of space (or a thumb's width) between the tip of the toes and the end of the shoe. The child should be able to comfortably wiggle his or her toes in the shoe.

A soft, pliable, roomy shoe such as a sneaker is ideal for all children. The toe box should provide enough space for growth, and should be wide enough to allow the toes to wiggle. (A finger's breadth of extra length will usually allow for about three to six months' worth of growth, though this can vary depending on your child's age and rate of growth.)

If your child frequently removes his or her shoes, those shoes may be uncomfortable. Check your child's feet periodically for signs of too-tight shoes, such as redness, calluses or blisters. And have your child's feet measured periodically at the shoe store to determine whether his or her feet have grown enough to warrant a larger pair of shoes.

Remember that the primary purpose of shoes is to prevent injury. Shoes seldom correct children's foot deformities or change a foot's growth pattern. Casting, bracing or surgery are often needed if a serious deformity is present. If you notice a problem, have your child examined.

Because high-top shoes tie above the ankle, they are recommended for younger children who may have trouble keeping their shoes on. Contrary to common belief, however, high-top shoes offer no advantages in terms of foot or ankle support over their low-cut counterparts.

Men's Shoes

Most men's shoes conform to the shape of the feet and have a roomy toe box with sufficient horizontal and vertical space and a low heel (usually about half an inch high). Soles made of hard materials such as leather or soft materials such as crepe can both be worn, but softer soles tend to be more comfortable. If you stand for extended periods of time, shoes with soft, pliable soles will protect your feet and help keep them comfortable.

The best shoes for men are good quality oxford styles, shoes ordinarily associated with wing-tip or cap toe designs. Also suitable are slip-ons, dressy loafers, and low dress boots.

It is advisable to have three to five pairs of shoes for business hours - general oxfords and loafers are usually suitable. Cushioned-sole shoes give good support for those who spend most of their working days on their feet.

Women's Shoes

Women inflict more punishment on their feet from improper footwear that can bring about unnecessary foot problems. Some of the problems result from high-heeled shoes (generally defined as pumps with heels of more than two inches). Our practice believes such heels are medically unsound because they can cause postural and even safety problems.

A study conducted by the American Orthopaedic Foot and Ankle Society found that:

Nine out of 10 women are wearing shoes that are too small for their feet.

Eight out of 10 women say their shoes are painful.

More than 7 out of 10 women have developed a bunion, hammertoe, or other painful foot deformity.

Women are nine times more likely to develop a foot problem because of improper fitting shoes than a man.

Nine out of 10 women's foot deformities can be attributed to tight shoes.

High-heeled, pointed-toe shoes can cause numerous orthopedic problems, leading to discomfort or injury to the toes, ankles, knees, calves and back. Most high-heeled-shoes have a pointed, narrow toe box that crowds the toes and forces them into an unnatural triangular shape. These shoes distribute the body's weight unevenly, placing excess stress on the ball of the foot and on the forefoot. This uneven distribution of weight, coupled with the narrow toe box characteristic of most high heels, can lead to discomfort, painful bunions, hammertoes. and other deformities.

The height of the heel makes a dramatic difference in the pressure that occurs on the bottom of the foot. As heel height increases, the pressure under the ball of the foot may double, placing greater pressure on the forefoot as it is forced into the pointed toe box.

To relieve the abusive effects of high heels, women can limit the time they wear them, alternating with good quality sneakers or flats for part of the day.

There are comfortable and attractive "walking" pumps (also called "comfort" or "performance" pumps) for work and social activities, that blend fashion considerations and comfort, offering pumps with athletic shoe-derived construction, reinforced heels, and wider toe room. Low-heeled shoes (one inch or lower) with a wide toe box are the ideal choice for women. An ample toe box that can accommodate the front part of the foot is as important as the heel in determining fit.

Perhaps the best shoe for women is a walking shoe with laces (not a slip-on), a composition sole, and a relatively wider heel with a rigid and padded heel counter, no more than three-quarters of an inch in height.

Aerobic Shoes

Proper shoes are crucial to successful, injury-free aerobics. Shoes should provide sufficient cushioning and shock absorption to compensate for pressure on the foot many times greater than found in walking. They must also have good medial-lateral stability. Impact forces from aerobics can reach up to six times the force of gravity, which is transmitted to each of the 26 bones in the foot.

Because of the many side-to-side motions, aerobic shoes need an arch design that will compensate for these forces, and sufficiently thick upper leather or strap support to provide forefoot stability and prevent slippage of the foot and lateral shoe "breakup." Make sure shoes have a toe box that is high enough to prevent irritation of your toes and nails.

Many agree that the old sneakers in your closet are probably not the proper shoes for aerobics. Major shoe companies today have designed special shoes for aerobics, which provide the necessary arch and side support; they also have soles that allow for the twisting and turning of an aerobics regimen.

Running shoes, perhaps the most popular of all athletic shoes, lack the necessary lateral stability and lift the heel too high to be considered proper for aerobics. They also often have an acute outside flare that may put the athlete at greater risk of injury in sports, like aerobics, that require side-by-side motion.

Buy your aerobics shoes in the afternoon, when your feet swell slightly. Wear the same socks (podiatrists recommend athletic socks made of an acrylic blend) that you will wear in training.

Baseball Shoes

For children under 10, sneakers are normally suitable for baseball. While cleats are generally not dangerous, children should break them in before bringing them to a game. While cleats may enhance play, they can expose your ankle to twists and turns. Children with pre-existing foot conditions should see a podiatric physician before putting on cleats.

Avoid hand-me-downs or bad-fitting cleats because they may increase the danger of ankle injuries. When sizing cleats, make sure the feet are measured properly, and always wear a game-size sock when trying them on.

In some competitive baseball leagues, the use of metal spikes is permitted. Spikes can be dangerous weapons on the base paths and require a certain level of maturity to be worn safely. They are not necessary for casual play, and should not be worn unless in league competition.

Spikes, which technology has made lighter and more flexible these days, perform the same function as cleats, but grab the ground differently. They too should be worn on a limited basis until the feel of how they engage the turf is understood. Unfamiliarity with spikes can lead to ankle twists and turns in a competitive situation.

When wearing cleats or spikes for the first time, watch for irritation, blisters, or redness, which could indicate a problem in the legs or feet. Pain is a clear indicator of a problem. If cleats cause pain, discontinue wear for two to three days; if it returns, contact our office for an evaluation.

Basketball Shoes

Proper basketball shoes have lots of ankle support and shock absorption. Some high-topped shoes offer more ankle support than others. Shoes should fit well and be replaced before the soles become smooth, or before the uppers begin to tear or come apart. A typical basketball shoe should be replaced every two to three months for five days a week worth of play. Acrylic socks should be worn to avoid blistering.

Basketball shoes should provide support for lateral movement and extra stability to guard against ankle sprains.

Cycling Shoes

Cycling enthusiasts will admit that shoes are the most important piece of cycling equipment next to their two-wheeled ride. Cycling shoes must have a stable shank to efficiently transfer power from your feet to the pedals.

Good shank support will prevent the foot from collapsing through the arch while pedaling. This could cause arch pain, tendon problems, or burning under the bottom of the foot. A rigid shank protects your feet from the stress of pedaling.

If you have a pre-existing problems with your feet or wear shoe inserts, invest in a cycling-specific shoe. Most special shoes prescribed a doctor control the arch and heel, and for cycling, usually require critical forefoot balancing. Riders with mild bunions or hammertoes should select a wider, deeper shoe that will accommodate the deformity.

Cycling shoes are usually categorized by racing and mountain biking. If you are not an avid cyclist and have no known foot problems, cross-training shoes will usually provide the necessary support across the arch and instep. They also provide the heel lift that cycling shoes give. Combination cycling-hiking shoes meet the needs of the casual rider well, and have recently become popular.

More serious cyclists invest in toe clips, which range from traditional to the newer shoe-cleats called "clipless systems," which resemble ski bindings.

Proper shoes and clips or cleats working as a unit are important to achieve maximum efficiency in transferring power generated by the hips to the foot. For most efficient pedaling, shoes should extend fully under the ball of the foot.

Golf Shoes

Wearing proper golf shoes is very important to your foot health. The "old fashioned" golf shoes were wing-tip oxfords with spikes. Golf shoes today are designed more like athletic footwear. Some even incorporate such innovations as graphite shank reinforcements, which keep them light and add strength.

Choose golf shoes as if you were choosing shoes for taking a good long walk. Ensure that your golf shoes fit well in the store before purchasing them.

If you already wear special inserts in your street shoes, transfer them to your golf shoes. Some special shoe inserts are designed specifically for golf shoes and will be different than those designed for street shoes.

If a round of golf leads to painful feet, check the quality of your shoes. Persistent pain even after choosing proper golf shoes means you should visit our office.

Jogging/Running Shoes

Running and jogging exert brute force on your feet, legs, hips and spine. Proper shoe selection is very vital to protecting these from injury or long-term problems.

Some general tips:

Fit the shoe to your longest toe, which is often your second toe.

Shoes should be comfortable when you first try them on. Don't buy shoes and plan to "break them in" by wearing them.

Take the same socks you'll use for jogging. They should fit well, be made without seams, which could cause irritation to the foot. If you use extra-thick socks while running, select shoes with enough room. Socks should be made mostly out of synthetic materials which "wick" moisture away from the foot. This reduces the chance of developing blisters.

The shoe should grip your heel firmly.

While the shoe is on your foot, you should be able to wiggle all your toes.

You should have at least 1/4 inch of space beyond your longest toe.

Weight, foot structure, and running regimen are all deciding factors. Be mindful that all shoes have a different shape, and sizes and widths are not uniform from shoe to shoe.

Consider whether a special insert will be placed in your shoe, and whether your running style is flat-footed or on the balls of the feet.

Shoes should provide cushioning for shock absorption, and ought to be able to fully bend at the ball of the foot area.

Soccer Shoes

Soccer shoes should offer a reinforced toe, wide toe box, soft leather, field-appropriate cleats, well-padded soles and a support system that can help prevent ankle sprains and knee injuries.

More than 25,000 people sprain their ankles every day, according to the American Orthopaedic Foot and Ankle Society.

Ankle sprains are caused by an unnatural twisting or force on the ankle bones of the foot, often resulting in one or more ligaments on the outside of the ankle to be stretched or torn. If not properly treated, ankle sprains could develop into long-term problems.

Treatment includes resting the ankle and applying ice to reduce swelling. Compressive bandages also may be used to immobilize and support the injury. More serious ankle sprains, particularly in competitive athletes, may require surgery to repair to tighten the ligaments.

Tennis Shoes

Experts advise that if you plan to play tennis, buy shoes designed specially for the sport. Running shoes, for example, are not designed to allow for the side-to side sliding common in tennis. Running shoes have too much traction and may cause injury to the foot and ankle. In addition, running shoes don't have padded toe boxes, which leads to toe injuries for tennis players.

Tennis shoes should provide good arch support, a reinforced toe, a roomy toe-box and a comfortable collar in the back of the shoe. If the collar is too high, it rubs against the Achilles' tendon, a problem frequently experienced by tennis players.

Heels in tennis shoes should be snug-fitting to prevent slipping from side to side, and both heel and toe areas should have adequate cushioning. The arch should provide both soft support, and the toe box should have adequate depth to prevent toenail injuries. Our practice can recommend a shoe that is best for your foot.

When shopping for tennis shoes, try on several pairs with tennis socks. Put on and lace both shoes and walk around for a minute or two. Make sure your ankles don't roll in the shoes.

Walking Shoes

Choose a good quality, lightweight walking shoe with breathable upper materials, such as leather or nylon mesh. Look for a very firm heel counter; the heel should have reduced cushioning to position the heel closer to the ground for walking stability. The front or forefoot area of the shoe should have adequate support and flexibility.

Your choice of athletic socks is also important. Choose padded socks made of acrylic fiber, which tend to "wick" away excessive perspiration. Active feet can produce sweat from 250,000 sweat glands at a rate of four to six ounces a day, or even more.

The ideal walking shoe should be stable from side to side, well-cushioned, and it should enable you to walk smoothly. Many running shoes fit all of these criteria well, and for most people are acceptable for a walking program.

However, there are specialty walking shoes that may work well for you. These tend to be slightly less cushioned, yet not as bulky, and lighter than running shoes.

Most important, whether you are wearing a walking or running shoe, is that it must feel stable to you. Either type of shoe is acceptable if it works well with your foot mechanics, providing cushioning and stability.

Here are a few tips when buying walking shoes:

Before buying, try this test. Place the shoe on the counter and make sure the heel is straight up when looking at it from the rear. Ensure that the midsole is well-connected to the upper and that the stitching is complete. Check inside the shoe for any irregular bumps.

Check on the shoe width; it must comfortably accommodate the width of the ball of your foot.

If you have bunions or other special considerations, consult our office about the best shoe for you. If you have prescription inserts, substitute your insert for the existing one (most shoes have a removable insole) to make sure it will fit properly, if possible.

Make sure you get good arch support.

Remember that every shoe manufacturer uses a different basic shoe shape. Some are shorter or longer than others of the same size; some fit a wide foot perfectly, while others are cut for a slimmer foot.

See that the top of the heel counter of the shoe is properly cushioned and does not bite into the heel or touch the ankle bones.

When the shoes are on your feet, the heel should be snug. If it slides in the store, it will slide while you are walking. You should be able to wiggle your toes in the shoe, and there should be one half to a full thumb's width between the end of the longest toe on your longer foot and the end of the shoe's toe box. Make sure your ankles don't roll in the shoes.

Winter Sports

Podiatrists say properly fitted ski boots and skates are the single most important factor in safe and successful skiing and skating. Without a snug and accurate fit, the pressure exerted by the constant forward motion and lateral movement of skiing and quick turns of skating could lead to discomfort or injury.

If boots and skates are too loose, toes quickly get irritated in the toe box. If they are too tight, pressure leads to blisters and abrasions that result in a host of painful problems and keep you indoors or, worse, compromise control and lead to an accident.

Tight footwear also may inhibit circulation of the blood vessels of the lower extremity and cause cold feet, which both compromises performance and presents danger in the cold.

Ski boots are available in a forward-entry variety, a rear-entry style for easier entry and more comfort, or "hybrids" which incorporate both designs.

Modern systems of cables and buckles make it possible to alter the boots to a near-perfect fit.

With ice skates, proper fit is equally important. Don't allow children to wear hand-me-downs because improperly fitted skates can cause blisters, inflammation of the foot, or nail irritation. Improper ankle support in a too-large skate will leave the ankle susceptible to sprains, strains, or fractures. Whatever the style, skates should be laced snugly, using all the eyelets.

Our practice can evaluate the fit and make recommendations to improve both comfort and performance on the ice or slopes.

Cross-country shoes look and are designed more like bicycle shoes than downhill boots. Bound to the ski only at the ball of the foot, cross-country boots should not irritate the balls of the feet.

Ski boots and skates can be adjusted internally to allow proper alignment between the boot and leg. For cases of rolling-in or rolling out of the foot, cants may be applied directly to the skis or within the boot. This improves edging and enhances performance and control.

Unlike ski boots, ice skates are more uniform in design. Common side-to-side wobbling in the heel area can be remedied with "shims," or pads, in the heel. Shims can also be added to the counter area, or middle of the skate, for a more snug fit.

Snow boarding usually doesn't require special shoes, but podiatrists say large, sturdy, insulated boots flexible enough to accommodate the twisting of the lower body are best to safely control the board.

Work Footwear

Work shoes are available in many shapes and have unique features and materials designed for specific occupations and uses. Thick leather boots with steel toe boxes can protect your feet. Boots with varying degrees of traction also are available.

The American Podiatric Medical Association offers the following guide that matches specific occupational hazrds with work footwear:


Falling and rolling objects, cuts and punctures

chemicals, solvents


Steel-toe safety shoes; add-on devices: metatarsal guards, metal foot guards, puncture-proof inserts, shin guards

Footwear with synthetic stitching, and made of rubber, vinyl or plastic

Corrective Shoes

Proper footwear is an important part of an overall treatment program for people with diabetes, even for those in the earliest stages of the disease. If there is any evidence of neuropathy, or numbness, wearing the right footwear is crucial.

People with diabetes should choose shoes that:

Accommodate, stabilize and support deformities such as Charcot foot, loss of fatty tissue, hammertoes and amputations. Many deformities need to be stabilized to relieve pain and avoid further destruction. In addition, some deformities may need to be controlled or supported to decrease progression of the deformity.

Limit motion of joints. Limiting the motion of certain joints in the foot can often decrease inflammation, relieve pain, and result in a more stable and functional foot.

Reduce shock and shear. A reduction in the overall amount of vertical pressure, or shock, on the bottom of the foot is desirable, as well as a reduction of horizontal movement of the foot within the shoe, or shear.

Relieve areas of excessive pressure. Any area where there is excessive pressure on the foot can lead to skin breakdown or ulcers. Footwear should help to relieve these high-pressure areas, and therefore reduce the occurrence of related problems.

Prescription footwear

Many diabetics need special prescription footwear. The various types include:

Custom-made shoes. When extremely severe deformities are present, a custom-made shoe can be constructed from a cast or model of the patient's foot. These cases are rare. With extensive modifications of in-depth shoes, even the most severe deformities can usually be accommodated.

External shoe modifications. This involves modifying the outside of the shoe in some way, such as modifying the shape of the sole or adding shock-absorbing or stabilizing materials.

Healing shoes. Immediately following surgery or ulcer treatment, some type of shoe may be necessary before a regular shoe can be worn. These include custom sandals (open toe), heat-moldable healing shoes (closed toe), and post-operative shoes.

In-depth shoes. The in-depth shoe is the basis for most footwear prescriptions. It is generally an oxford-type or athletic shoe with an additional 1/4- to 1/2-inch of depth throughout the shoe, allowing extra volume to accommodate any needed inserts or orthoses, as well as deformities commonly associated with a diabetic foot. In-depth shoes also tend to be light in weight, have shock-absorbing soles, and come in a wide range of shapes and sizes to accommodate virtually any foot.

Orthoses or inserts. An orthosis is a removable insole which provides pressure relief and shock absorption. Both pre-made and custom-made orthoses or inserts are commonly prescribed for patients with diabetes, including a special "total contact orthosis," which is made from a model of your foot and offers a high level of comfort and pressure relief.

Perimeter Orthopaedics
5673 Peachtree Dunwoody Rd, Suite 825
Atlanta, GA 30342
Phone: 404-255-5595
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