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Foot Problems: Could You Be Wearing the Wrong Shoes?

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A Woman's Aching Feet | Athlete's Foot | Blisters | Bunions | Corns and Calluses | Hammer Toes | Heel Pain | Buying Shoes

The average person walks more than 115,000 miles in a lifetime. Every walking step you take exerts pressure up to three times your body weight on your feet. Running exerts up to ten times your body weight. We cram our feet into tight-fitting, stiff shoes; subject them to the unnatural angles of high heels; pound them on pavement and asphalt; smother them in airless socks and shoes; or simply stand on them for hours on end. It's no wonder that the skin, 26 bones, and intricate webbing of muscles and ligaments in each of our feet sometimes can't stand up to the pressure.

Many common foot ailments are related to choice of shoes, especially in women. Of the 356 women involved in a survey by the American Orthopaedic Foot and Ankle Association (AOFAS), 80% had some kind of foot pain. That's no surprise when you consider that 88% of them were wearing shoes that were smaller than their feet! Footwear that is too tight, too loose, excessively airtight, or shaped in unnatural ways can cause or aggravate problems. Here are just some of the problems poor footwear can cause.

A Woman's Aching Feet

Nearly half of all women have first-hand experience with the dull throb of aching feet. Although an increase in standing or walking may be the cause, the culprit is often ill-fitting shoes. Because the fat padding on the bottom of the feet thins out over time, older women may find that this problem increases with age.

Athlete's Foot

Despite its name, this condition isn't limited to long-distance runners or other athletes. The intense itching, burning, pain, and scaling that usually occurs between the toes or on the sole of the foot is caused by microscopic fungi called Trichophyton mentagrophytes. These microorganisms thrive in warm, moist places—shower floors and sweaty socks or tight-fitting shoes are favorite environments.

Blisters

Shoes that are too big or too small or rough spots in shoes or socks can often rub against a sensitive spot on your foot. The body reacts by creating a fluid-filled sac, which you know as a blister. The skin underneath the blister is quite tender, making blisters very painful to walk on. Fortunately, they generally disappear on their own if kept clean and protected from further irritation.

Bunions

If you've noticed a lump on the side of your foot at the base of your big toe, it's probably a bunion. Bunions are caused when the base of the toe is pushed out of its normal position. This causes a bulge on the side of the foot that can be painful and inflamed. Rather than pointing straight ahead, the big toe will also frequently press against the other toes.

Corns and Calluses

The skin protects itself against repeated friction and pressure by building up hard layers of skin cells at the site of the irritation. When this happens on top of or between the toes, the skin cells form round, kernel-like bumps, called corns. Calluses usually form on the sole, and are thick, yellowish, and flat.

Hammer Toes

When one of the smaller toes takes on a claw-like appearance, it's called a hammer toe. Misalignment of the toe joints or muscle or nerve problems in the foot cause the toe to curl up instead of laying flat. People with diabetes are prone to developing hammertoes. Wearing shoes that are too short can also cause this problem.

Heel Pain

Flat feet, high arches, or physical activity such as running can trigger inflammation and soreness in the plantar fascia ligament, which runs between the heel and the ball of your foot. The resulting inflammation is called plantar fasciitis.

Pain from plantar fasciitis usually comes with the first steps of the day or after long periods of inactivity. Plantar fasciitis may also lead to calcifications (heel spurs) at the point where the fascia attaches to the heel. Both plantar fasciitis and resultant heel spurs may be due to poorly fitting shoes, a sudden increase in physical activity, or foot stress due to sudden weight gain.

Combination of relative rest, shoe orthotics, and gentle stretching will take care of the problem in most situations.

Buying Shoes

Any injury to the foot interrupts the kinematic chain (the foot bone's connected to the ankle bone, and on up), hampering mobility. High heels and pointy-toed fashion shoes are natural adversaries to your feet. Although the angle of high heels may make your legs look long and graceful, it also increases pressure on the toes and upsets your balance. Keep your use of high heels to a minimum, and opt for flats instead.

Sport-specific shoes are engineered to provide the support, motion control, and cushioning that minimize foot injuries associated with a particular activity. One good pair of cross trainers will suffice for every sport you participate in. Sports shoes can be worn every day for cushy comfort. However, they will lose their cushioning effect over time and should be replaced if the lining no longer bounces back when you press on it.

Remember to check shoes for air flow—do they have porous fabric or air holes so that your feet won't swelter inside? The toe should be more rounded than pointed, approximating the natural shape of the foot. With one hand on the heel and the other on the toe, try to bend the shoe—does it give? If it doesn't flex, it's probably too stiff. Next place the shoe on the floor and push it forward—is there any resistance? Shoes with poor tread design or smooth bottoms can lead to slips and falls.

Although shoe construction certainly matters, fit is really the key element in keeping your feet healthy. Consider getting your feet measured. Your feet may well have increased in size, as commonly happens as women grow older. Be sure to shop for shoes at the end of the day, when your feet are 5%-8% larger than in the morning. Measure both feet, since they are often different sizes, and always fit to the larger size. Allow 1/2" of room between your longest toe and the end of the shoe. Feel along the sides of the shoe while it's on your foot to check that the widest part of your foot corresponds with the widest part of the shoe. Take a test stroll across the store to verify that the shoe flexes when you walk, and that your heel doesn't slip in and out. Wear the hosiery or socks you expect to wear with the shoes.

The most important test of all is completely subjective: Are they comfortable? A particular pair of shoes may look great, but if they're going to leave you sore or limping, leave them in the store. Be kind to your feet—they've got to carry you a long way.

RESOURCES:

American Podiatric Medical Association

http://www.apma.org

CANADIAN RESOURCES:

Canadian Podiatric Medical Association

http://www.podiatrycanada.org/

References:

Artunian J. If the shoe fits... Current Health 2. 1995 Feb.

Bunion. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 13, 2011. Accessed May 6, 2012.

Callus. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 19, 2011. Accessed May 6, 2012.

Corn. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 10, 2010. Accessed May 6, 2012.

Frey C, Thompson F, Smith J, et al. American Orthopaedic Foot and Ankle Society women's shoe survey. Foot & Ankle. 1993 Feb.

Furey, JG. Plantar fasciitis: The painful heel syndrome. J Bone Joint Surg. 1975; 57A:672.

Hammer toe. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 25, 2010. Accessed May 6, 2012.

Moser PW. Foot pain? The steps to ease your troubles. New Choices: Living Even Better After 50. 1996 April.

Plantar fasciitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated Oct 20, 2011. Accessed May 6, 2012.

Riddle DL, Schappert SM. Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int. 2004; 25:303.

Sanders L. Foot care: A step-by-step guide. American Health. 1995 Sept.

Last reviewed May 2012 by Brian Randall, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.