I have problems with shoes – HELP!

Article by Dr Anita Williams

Why are shoes so important?

We all have to wear shoes to protect our feet from the environment, and it is crucial that they are the correct design, not just to accommodate our feet comfortably but for the activity that we are doing. Over a lifetime, our feet will walk the equivalent of five times around the world, so it is important that we invest time in choosing the right shoes.

For people with conditions that affect the feet such as rheumatoid arthritis, the right footwear is essential to maintaining the function, resting symptomatic joints and preventing or limiting structural foot problems. Where disease control with medical management is relatively good, addressing the mechanical causes of foot problems before changes in the feet become well developed can have significant benefits. The right footwear has a large role to play in the management of foot mechanics in the early stages of the disease.

When disease management has been difficult to achieve and varying degrees of structural foot problems are evident, the right footwear is essential to accommodate the forefoot joints and toes, support the rearfoot and protect the foot from trauma.

However, footwear is much more than a protective wrapping for the feet and an aid to function. Although shoes have been described as ‘the principle intersection between the body and physical space’ that allow us to move around our environments and experience the world in which we live, they also have a powerful influence on social and emotional aspects of our lives. In this respect, footwear acquires different roles and has different meanings dependent on a person’s taste, identity, social status, and gender. Here lies the challenge: for people with feet that may be painful, swollen, wider and deeper than the average foot, finding footwear that is both comfortable and suitable for all occasions, including social events can be a difficult task.

What is the best footwear?

There are many manufacturers of high street footwear that provide a variety of styles and widths which will accommodate the majority of feet and foot problems. It is difficult to recommend particular manufacturers and styles, as all feet are different. These differences are not just in length but in the width of the forefoot, depth over the toes and the instep, arch height, flexibility of the joints, and angle of the toes to name just a few of the variations. Each manufacturer’s designs will vary in relation to all these aspects and so matching the right feet to the right footwear can sometimes feel a bit of a lottery. Do not rely on shoe size alone – it is the fit of the shoe and how you feel in the shoes that are more important. Size is just a guide – there are some important tips and advice in the next sections that should make choosing shoes easier.

What shall I do when I am looking for the right shoes?

Here is some general advice for when you are planning your purchase:

1. Try and find a shoe shop with a shoe fitter who can provide guidance as to the right design of shoe for your feet or an online shop with a free returns policy. The Healthy Footwear Guide contains contact details for organisations that can provide you with a list of manufacturers that have fulfilled the requirements to be registered with the Health Footwear Group which is supported by The Society of Shoefitters and the British Footwear Association.
2. Feet tend to swell during the day, so buy shoes in the afternoon when your feet are at their largest.
3. Make sure you try on both shoes as your feet may be a different size and width.
4. Have your feet measured if they’ve become wider over the years, or have changed shape because of arthritis. Your feet may change shape when you stand up, so have them measured while standing.
5. Make sure you try on shoes that have not been on display as these shoes will have been tried on frequently and may have stretched.
6. Take your time and walk around the shop in the shoes. Even if they are comfortable in the shop make sure that you can return them for a full refund if you find that they are uncomfortable by wearing them for slightly longer at home (take care not to damage the soles on hard floors as they then cannot be returned).
7. Don’t be tempted to buy shoes in a ‘sale’ unless they fit perfectly and are comfortable.

What do I look for in a good ‘every day’ shoe?

When you have joint problems and painful feet, then comfort and support for your feet is a priority, particularly for high levels of activity such as shopping and walking distances.

As a general rule, it is desirable to reserve higher heels and strappy shoes for social occasions when you spend little time on your feet – these are what I call ‘car to bar’ shoes where they are essentially an adornment to your feet rather than something to walk in. If you are planning an important social event, then you may benefit from resting your feet as much as possible before the event, i.e. don’t plan a long walk or shopping trip the same day so that your feet won’t be as swollen and sore.

As far as your everyday shoes go, these are important fitting points to look out for when choosing the right shoes:

1. Length

• the general rule is that shoes should be long enough to have ½ inch or 1cm space between the longest toe and the end of the shoe.
• However, if you have a bunion and/or clawing of the toes you need to have shoes that are the length that your foot would be if all your toes are straight – this is so the widest part of your foot fits into the widest part of the shoe. 

Above: Diagram showing the heel to ball measurement
Below: Image of feet with different heel to ball/ball to toe measurements

The foot on the left is affected by RA, and the one on the right is a normal foot. These feet are the same length overall, but the one on the left has a short ‘toe to ball’ measurement due to the lesser toes being retracted and the big toe drifting over. If shoes are purchased to fit the overall length of the left foot, then the widest part of the foot will not be at the widest part of the shoe. Therefore, it is important for people with toes such as these to buy shoes to the length of the foot as it would be if the toes were straight.

2. Width

• The shoe should be wide enough so that the upper material is not pushed out of shape or forced to bulge over the side of the sole.
• There should be some ‘give’ in the upper over the forefoot but not so much that there is creasing.
• Make sure that the width at the heel is right. Some shoes that are wide enough at the front are too wide at the heel and may slip off.

3. Depth

• The front of the shoe over the toes should be deep enough to accommodate any toes that may be clawed.
• There should be sufficient depth over the instep for you to easily get your foot inside the shoe. Alternatively, a lace-up shoe with more than 3 eyelets will open up sufficiently for you to get your feet into easily.

4. Size varies between shoe brands and style. Judge a shoe by how it feels on your foot and not just by the size marked on the shoe. Think about how the shoe fits around your toes, under the soles, and at the back of the heels.

5. Try shoes on with the type of socks or stockings you normally wear, or with any insoles or orthoses, you normally wear with them. Some insoles may need extra depth, especially in the toe area.

6. If you are worried about the appearance of your feet, dark colours and a suede finish may help to disguise the problem.

These are important features to look out for when choosing the right everyday shoes:

1. It is best to choose shoes that are made from leather or a material that will conform to the shape of the foot. However, do not buy shoes if they require ‘breaking in’ and do not accept footwear if the salesperson says that they will ‘give’. The risk of this is that they might cause damage to vulnerable areas of the foot.
2. The shoe linings should be of leather or of breathable material that will disperse moisture.
3. The soles and heel should be of a material that is firm enough to provide support to your feet and the shoe uppers but soft enough to provide good shock absorption.
4. The shoes should have a broad and stable heel with a height which doesn’t put pressure on the ankle joint or the forefoot (the recommended heel height is no more than 4cm or 1 1/2inches but the ideal heel height from one individual to the next will vary in relation to the structure and function of the foot and leg).
5. The shoe should have a fastening (either lace, strap or Velcro) which is needed to hold the foot in the back of the shoe to prevent slippage.
6. The back of the shoe above the heel (heel counter) should be firm enough to support the rear of the foot, but the top edge should not dig into the foot.

What do I do if I am struggling with fastenings on shoes?

Lace-up shoes can be difficult to fasten if you have arthritis in your hands. However, there are a number of alternatives available, which will make your life easier.

A few alternative suggestions include:

• Elastic laces can be easier to use because one pull ensures a snug fit, and they don’t need to be tied again.
• Many shoes are now available with Velcro fastenings, which can be fastened and adjusted using only one hand.
• A zip fastening can be easier to manage than laces or buckles, and a ring (such as a key-ring) added onto the zip pull can make it easier to pull up.

There are also a number of devices currently available to help people with putting on socks, tights/stockings and shoes.

Should I be wearing slippers around the house?

Many people prefer to wear slippers in the house rather than shoes as they are often soft and comfortable for clawed toes and prominent joints. However, there are some negative aspects to wearing slippers which you need to consider before choosing them as your ‘house footwear’:

• Slippers aren’t a good idea for those who have to wear special insoles or foot orthoses. They do not provide the additional support needed to ensure the maximum benefits can be achieved from the insoles/foot orthoses.
• Slippers also sometimes contribute to falls in older people.
• The soles can lack adequate cushioning, and they can be generally unsupportive.
• Backless slippers and slippers with a high heel should not be worn as they are both unsafe and do not provide stability.

Therefore, slippers should be reserved for foot protection and warmth whilst resting or for low levels of activity. The features of the ideal slipper are generally the same as for the ideal shoe.

If you are doing tasks within the home such as ironing or cooking which require standing for long periods, then it is advisable that you wear your shoes rather than slippers particularly if you have been provided with special insoles or foot orthoses.

Slippers should be replaced as soon as the uppers, linings or soles start to wear out as in this state they can increase the risk of trips and falls and additionally can cause sore areas on the skin of the feet.

What do I do when it comes to ‘social footwear’? 

It is not recommended that high heels or court shoes are worn for everyday footwear, particularly if you need to wear foot orthoses. Foot orthoses generally don’t fit into court shoes, but it may be that the addition of a cushioning insole may be of some help in providing comfort.

However, there may be occasions when this type of footwear can be used for periods of low-level activity, such as social events when you are sitting down for most of the time.

The following are some tips for wearing higher heels and /or court shoes:

1. Do not wear brand new court shoes for a special event unless you have worn them for short periods around the home over the duration of a few weeks.
2. Wear them for very short periods and always keep a pair of comfortable shoes handy in case you are desperate or to go home in.
3. Walk much slower and reduce your stride to reduce the impact on your feet.
4. Rest your feet before the important social event.
5. Often a shoe with a platform will offset the height of a heel and therefore reduce pressure on the forefoot, i.e. a platform of 1cm will reduce the ‘functional’ overall height of a heel by 1cm.

What about insoles?

These range from simple cushioning insoles to foot orthoses. Foot orthoses are a type of moulded insole that is used to modify the structural and functional characteristics of the foot. They can be standard ‘off the shelf orthoses’ or made specifically for the individual person using an impression of the foot and are therefore termed ‘bespoke’. Whichever design is chosen or supplied, the footwear has to both accommodate and complement the function of these additions to the footwear. A podiatrist or an orthotist can provide advice about the most suitable type of insole/ orthoses for your needs.

What are the options if I just can’t find retail shoes to fit?

Specialist / prescribed footwear

Some people may have footwear prescribed especially for them by their consultant, GP or podiatrist. The shoes are usually provided by an orthotist who works in the orthotic services of NHS Trusts. You can also opt to see an orthotist or orthopaedic shoemaker privately. Each NHS hospital trust will have its own arrangements for footwear referral and entitlements. This footwear can be what is termed ‘stock footwear’ which is extra deep and wide or made to measure (bespoke) footwear made to a last specifically for your feet. Styles are often limited in comparison with retail footwear, and you may wish to discuss options and look at the styles available before you decide whether you should be referred or not.

The importance of footwear repair

You may feel that the footwear is more comfortable when very ‘worn in’, but the lack of support can cause problems. Whether your footwear is specialist or purchased on the high street, it is important that you have the heels of your shoes repaired on a regular basis. Heavy heel wear can contribute to poor foot function and poor stability. Once the upper part of the footwear is aged over time, particularly around the heel counter, this will not provide the support that the footwear originally gave you.

For a list of registered podiatrists

Contact the College of Podiatry:

The College of Podiatry
Quartz House
207 Providence Square
Mill Street
London SE1 2EW

Tel: 020 7234 8620

https://rcpod.org.uk/contact