Our podiatric doctors are firm believers that orthopedic therapeutic shoes and foot orthoses play an intricate role in allowing the patient to lead a pain free lifestyle as well as playing a major role in prevention of an amputation.
Dr. Reyzelman is a board-certified pedorthist. A certified pedorthist is an individual who has studied foot anatomy and pathology, biomechanics, shoe construction and modification, foot orthosis fabrication and materials, and footwear fitting.
Medicare has now recognized that therapeutic diabetic footwear benefit to lower the incidence of diabetic foot complications such as ulceration and amputation in the diabetic population. Due to the preventive nature of this program, a patient may qualify for shoes and inserts without a history of any foot complications.
Studies have shown that when therapeutic footwear (theraputic shoes) is worn at least 50 percent of the time there is a significant reduction in the incidence of foot ulcerations.
As important are diabetic orthotics that provide cushioning the plantar surface of the foot. Diabetic foot orthotics should have a total contact fit which helps to redistribute the pressure on the bottom of the foot more evenly. In addition, total contact orthotics help to reduce the shearing forces by maintaining the foot in a relatively fixed position, minimizing horizontal and vertical foot movement.
Proper footwear can reduce foot problems
From ancient Egyptian times down through the centuries, footwear has been designed to meet mankind’s real and perceived needs—protection, support, comfort, sturdiness, and stylishness.
Feet endure tremendous pressures of daily living. An average day of walking brings a force equal to several hundred tons on them. They are subject to more injury than any other part of the body, underscoring the need to protect them with proper footwear.
When a child begins to walk, shoes generally are not necessary. Allowing an infant to go barefoot indoors, or to wear only a pair of socks, helps the foot grow normally and develop its muscles and strength, as well as the grasping ability of toes.
As children grow more active, and their feet develop, the need for shoes becomes apparent. It becomes necessary to change shoe sizes at a pace that frequently surprises and even dismays parents, to allow room for growth.
When purchasing shoes for children, remember these tips:
- 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.
- The child’s foot should be sized while he or she is standing up and fully 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.
- 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.
- Shoes should not slip off at the heels. Children who tend to sprain their ankles will do better with high-top shoes or boots.
- Both feet should be measured, and if they are two different sizes, shoes should be chosen that fit the larger foot best.
Women inflict more punishment on their feet in part 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). Doctors of podiatric medicine believe such heels are medically unsound and attribute postural and even safety problems to their use.
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.
They can also vary heel height. There are comfortable and attractive “walking” pumps (also called “comfort” or “performance” pumps) for work and social activities, that blend fashion considerations and comfort. These pumps offer athletic shoe-derived construction, reinforced heels, and wider toe room.
Activity has a bearing on the considerations; wearing the right shoe for a particular activity is probably as important a factor in the choice of shoes as any.
Perhaps the best shoe for women is a walking shoe with laces (not a slip-on), a polymerized composition sole, and a relatively wider heel with a rigid and padded heel counter, no more than three-quarters of an inch in height.
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.
Men as well as women should buy shoes for work, leisure, and special activities, matching the shoe to the activity.
Male (and female) office workers should earmark three to five pairs of shoes for business hours—general oxfords and loafers for men; pumps and oxfords for women. Cushioned-sole shoes that give good support are essential for those who spend most of their working days on their feet.
There is no question about the need for foot protection for those who work in heavy industry. Safety shoes and boots—those that are waterproof or water-resistant, with insulated steel toe caps and soles of non-conducting materials—help prevent injuries to the feet and reduce the severity of injuries that do occur.
Shoes for Athletics
Different sports activities call for specific footwear to protect feet and ankles. Sports-specific athletic shoes are a wise investment for serious athletes, though perhaps a less critical consideration for the weekend or occasional athlete; nevertheless, it’s a good idea to use the correct shoe for each sport. Probably a more important consideration is the condition of the shoe—don’t wear any sport or other shoes beyond their useful life.
Athletic footwear should be fitted to hold the foot in the position that’s most natural to the movement involved.
For example, a running shoe is built to accommodate 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. But if a child is involved more heavily in any single sport, he or she should have a shoe specifically designed for that sport.
For longer service, keep shoes clean and in good repair. Avoid excessive wear on heels and soles. Give your shoes a chance to breathe—don’t wear the same pair two days in a row (you prolong the life of shoes by rotating their use). Never wear hand-me-down shoes (this is especially important for children).
- Have your feet measured while you’re standing.
- Always try on both shoes, and walk around the store.
- Always buy for the larger foot; feet are seldom precisely the same size.
- Don’t buy shoes that need a “break-in” period; shoes should be comfortable immediately.
- Don’t rely on the size of your last pair of shoes. Your feet do get larger, and lasts (shoemakers’ sizing molds) also vary.
- Shop for shoes later in the day; feet tend to swell during the day, and it’s best to be fitted while they are in that state.
- Be sure that shoes fit well—front, back, and sides—to distribute weight. It sounds elementary, but be sure the widest part of your foot corresponds to the widest part of the shoe.
- Select a shoe with a leather upper, stiff heel counter, appropriate cushioning, and flexibility at the ball of the foot.
- Buy shoes that don’t pinch your toes, either at the tips, or across the toe box.
- Try on shoes while you’re wearing the same type of socks or stockings you expect to wear with the shoes.
- If you wear prescription orthotics—biomechanical inserts prescribed by a podiatric physician—you should take them along to shoe fittings.