What shoes should I get? 👟

As PTs, we get this question all time. There are so many types of shoes to pick from. Should I switch to barefoot shoes? Should I have arch support? How much cushion do I need? Most of us wear shoes for the majority of the day, so we better be wearing shoes that are good for our feet to keep our bodies feeling good. Since our feet are our foundation, choosing the wrong shoe could be setting you up for issues down the road. There are four main things that I think about when trying to choose a shoe: stack height (cushion), heel to toe drop, toe box width, and flexibility.

First, let’s talk about stack height. Why do we care how tall our shoes are? Well, the amount of cushion that we have correlates directly to how much foot stability we have. Think about it this way- if I were standing on a block of foam, I would be much less balanced than if I were standing on concrete. This is because the foam moves and changes shape as we change the pressure on different parts of our foot. So why would be want to be less balanced? Ideally, I have people in as little cushion as they can comfortably tolerate. For me, I have found that my sweet spot is with a low to moderate cushion running shoe. For others, they may feel very comfortable in a fully barefoot shoe that has little to no cushion.

What about heel to toe drop? Heel to toe drop is the amount that a shoe has a decline forward from the heel to the toe. Most shoes have some amount of heel to toe drop. Again, I recommend that people are in the least amount of heel to toe drop that they can comfortably tolerate. In the clinic, one of the most common problems we see at the foot and ankle is a lack of dorsiflexion mobility (being able to bend at your ankle so your knee

goes over your toes). A lack of dorsiflexion can be a compounding factor in several different issues including foot/ankle pain, knee pain, and hip pain to name a few. This is because we need this movement to be able to walk, squat, lunge, etc. and if we can’t move into it, our body will compensate elsewhere. In order for us to maintain our dorsiflexion mobility, we can wear a shoe that is near flat to make sure that your ankle has to bend. If you’re coming from a shoe that has a lot of heel to toe drop, you may want to consult your physical therapist about different exercises/stretches to promote better dorsiflexion mobility to help ease the transition.

Thirdly, we have toe box width and this, I believe, is the most important. Have you ever had a bunion or known someone with a bunion? Well chances are, they wore shoes their entire life that were extremely tight in the toe box. While we can’t completely contribute the bunion to the shoes, it is one of the biggest factors we see contributing to the big toe pulling in. Why is this a problem? The big toe contributes to a large majority of your foot’s stability. Without it, it would be very difficult to walk, stand, squat, etc. without falling over. The big toe does much more than most of us think to provide the foundation of our body. By wearing a shoe with a wide toe box, we can ensure that our big toe has plenty of room to move.

Lastly, flexibility is a consideration when choosing a shoe that will be good for your body. Flexible soles allow your foot to conform to the ground in every stride just like your foot would do if you weren’t wearing shoes. The shoe has to be able to bend easily in all the areas your foot bends in a normal stride. If your shoe is too rigid or has too much support for your body, you will not be maintaining your body’s natural foot and ankle mechanics. As PTs, we’re constantly helping people regain mobility in the ankle, foot, and big toe. Ensuring your shoe is flexible enough for those movements to occur is a great way to maintain mobility.

While there are several other factors you might consider when picking a shoe, these four components are a good start to help you find something that works well for you. Depending on personal factors and injuries, some people may need more/less of each of these components. If you have more questions about what shoes would be best for you, consult your PT next time you’re in the clinic!

Cole Miller PT, DPT, CF-L2