women in high heeled shoes

Just because the shoe fits, doesn’t mean you should wear it

There are good shoes and there are bad shoes. When you choose appropriate shoes for your activity, you help prevent injury, support foot and gait health and you’re more comfortable, too.

Shoes matter.
When you wear shoes, you’re not just making a statement about your style, shoes can keep your feet healthy, prevent injury and make physical activity more comfortable.

What a shoe should do
A well-designed, well-fitting shoe should support and cushion the foot. A shoe should feel snug, comfortable and supportive, but not tight, with about 1-1.5 cm of space between the longest toe and the end of the shoe. Most cushioning happens in the midsole area of a shoe. And while a shoe doesn't actually reduce the force that goes through the body, it can increase the time taken for that force to apply, giving the body time to adapt.

The trouble with the wrong shoes
If your shoes are too tight, too loose or insufficiently supportive, you could be placing stress on your feet, ankles, lower legs and other joints during normal activity. Athletic activity can amplify this stress, which contributes to pain and injuries like shin splints, Achilles tendon pain, corns and bunions, ingrown nails, postural issues and lower back pain. Wearing the wrong shoe can exacerbate existing problems such as pain or arthritis in your hips, knees, ankles, back or feet.

At a more basic level, shoes affect how you walk. The movement of your feet during each step determines how the rest of your body responds and stepping incorrectly can cause problems up the line – e.g. in your hips and back. Some people’s arches roll inward too much, or not enough. If the shoe is not compensating for this defect, the feet will not absorb shock effectively. This can contribute to additional stress on other joints.

Dr. Richard Hayes of Great Basin Orthopaedics has seen the consequences of poor shoe selection during his 25-year career. “Rarely does a patient with back or knee pain consider that their choice of footwear is contributing to their problem,” Dr. Hayes explains. “It’s not always a fall or an accident. A job that requires you to be on your feet while wearing unsupportive shoes can be enough to cause a problem.”

RELATED: Good pain. Bad pain.

Notoriously bad shoe choices

High heels totter at the top of the bad shoe list

  • All heels over 2” put pressure on the ball of the foot and the higher, the more intense the pressure.
  • The rigid back of a pump presses on the back of the heel and can create a bony protrusion that rubs, swells and otherwise hurts, often called a “pump bump.”
  • Teetering on high heels puts you at-risk of ankle sprains from rolling off those heels. The narrower the heel (think stiletto), the bigger the danger.
    You can be fashionable and dressy without sacrificing your body. Aim for a modest height and a wider, more stable heel.


Ballet flats fall flat when it comes to foot support

  • These shoes offer no arch support and have thin soles that contribute to plantar fasciitis, knee, hip and back problems.
    Either choose a flat shoe with a thicker sole and more support or get some inserts to provide additional support and cushion to your ballet flat.


Flip-flops are a real flop for healthy feet

  • Not only is there no arch support in a flip-flop, but you expose your feet to cuts, splinters and other injuries.
    Wear flip-flops judiciously – e.g. for short periods of time when conditions warrant. Sandals with thicker soles and more structure allow you to show off your pedicure while providing more support.


Pointy shoes/boots

  • Yes, we are in cowboy country here in Nevada, but that does not mean our feet are made for cowboy boots. The triangular toe box of most cowboy boots (and many other boot styles) does not reflect the actual shape of feet, so wrangling them into a shoe of that shape is not a good idea. Whether heels or flats, cowboy boots or dress shoes, possible consequences include nerve pain, bunions, blisters, and hammertoes.

“In my experience, high heels are the shoe that has wreaked the most havoc on our patients over the years,” Dr. Hayes explains. “I understand some people need to wear heels for work, but no workplace wants to disable its employees. Today’s healthy options are much more fashionable than they were 10 or even 5 years ago.”

6 shoe shopping tips

  1. Shop for shoes after exercise or in the afternoon when your feet have naturally expanded.
  2. Get both feet measured every time as they change over time (an almost always after pregnancy). Buy a size appropriate for the larger foot if they are different sizes.
  3. Wear the same type of socks to the store that you intend to wear with the shoes – e.g. If you’re buying athletic shoes don’t wear thin dress socks.
  4. Find shoes that fit correctly now. Shoes should not need to be “broken in” to accommodate your foot comfortably. A good shoe store clerk should be able to help with this, but in their absence:
  • Make sure the width is adequate – ask for a wider size if necessary.
  • Do the wiggle test – can you move your toes?
  • There should be about ½ inch between your longest toe and the end of the shoe when standing. This allows for your foot to press forward as you walk.
  • Is your heel slipping? The shoe is not a good fit if your heel comes up.
  1. Check the soles – are they sturdy, grippy? See how they feel on carpet and hard surfaces. If the soles are slick but still supportive, consider scuffing them on a rough surface (like concrete) before wearing. No one will see the bottom and you’ll reduce the risk of slipping.
  2. Take them for a test drive – e.g. Walk and or jog around the store to see how they feel.

RELATED: Getting to the bottom of shin splints.

Pick the right shoe for the job

You can get away with wearing a flip flop down to the beach, but you shouldn’t spend a day at the amusement park in them. The chance of injury increases if your shoes are not designed for your activity or the conditions.


Look for a lightweight shoe and extra shock absorption in the heel and under the ball of your foot. These features may help reduce heel pain, burning or tenderness in the ball of your foot.


Look for shock absorption and good torsional strength (meaning the shoe shouldn’t twist easily). These features may help protect against shin splints, tendonitis, heel pain, stress fractures and other overuse injuries.


Folks who work on their feet all day — healthcare workers, food servers, construction workers, etc. — need it all. Good arch support, a deep heel cup and a thick, shock-absorbing sole. 

Shoes can correct foot position

If you have flat feet, your feet overpronate (rolls inward during movement more than 15%), you have trouble with plantar fasciitis (heel pain) or if you have arthritis in your lower limbs, shoes with maximal support will feel better. These shoes have built in motion control from a rigid elevated arch and help limit pronation. They tend to have stiff soles.


RELATED: Life-Changing Foot Surgery

Your best ally when looking for a good shoe – versus a bad shoe – is a knowledgeable shoe salesman. “When my patients need more supportive footwear, I refer them to A Proper Fit or Reno Running Company,” says Dr. Hayes. “The staff understands fit and there is a wide selection of shoes for a variety of activities that support foot health.”

Is this article a day late and a dollar short for you? If you’re looking to alleviate chronic foot, shin, ankle or back pain, contact Great Basin Orthopaedics. Our surgeons and physical therapists have the skill and understanding to treat your injury and get you back to life.