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Shoes, arch supports and heel cups

By Kate Zanoni, LPTA

We get inquiries from patients all the time regarding footwear, flip flops and arch supports. Which type of shoes is right for you? Well, there is no one-shoe-fits all. The answer is more involved and depends upon your foot structure, your activity/sport, your gait pattern and your goals.

Not all flip flops are created equally. There are some flip flops that are extremely flat and flimsy. These types of flip flops provide no support for your feet or ankles, which puts you at a higher risk for developing plantar fasciitis, tendonitis or sustaining an ankle sprain.

However, not all hope is lost. It’s summer time and I love wearing flip flops, too. I have very high arches, so I need flip flops that have more medial support in the arch. If you have very flat feet, you also need an extra boost of support.

Arch supports

Unless you have a foot deformity or underlying condition, most of the general public does not need a customized orthotic. Arch support technology has advanced over the years and most over-the-counter arch supports such as Dr. Scholl’s, Super Feet, and Soft Soles are sufficient for most people.

At LSTC, our physical therapists, physical therapist assistants and athletic trainers can analyze your foot structure, static/dynamic stability and gait pattern to help you determine your individual needs.

When choosing supportive footwear, I also recommend having your gait analyzed at a running store by a specialist who is well-versed in the latest shoe technology. My caveat is to avoid the latest craze or trend in the footwear world. Zero drop shoes and minimalist shoes have become popular in recent years, but they are not appropriate for everyone.

Here is a breakdown of different parts of a shoe, different types of shoes and what to look for when you’re going shoe shopping.

  1. What is the function of footwear?
  • Stability
  • Protection
  • Shock Absorption
  1. What is the patient’s goal in choosing better footwear?
  • Pain relief
  • Improve biomechanics
  • Performance

Consider four main parts of shoe:

  • The Last (the solid form around which a shoe is molded)
    • Includes the heel height, toe box and toe cap (rounded, pointed square) and instep
    • Should represent the anatomical information of the foot (function over fashion)
  • Toe Break
  • Heel Cup
  • Midsole (firm or soft….the layer sandwiched between the upper sole and outsole)
  1. Does the patient need shock absorption OR motion control?
  • Flat feet = need more stability (build up arch support, decrease pronation)
    • Rigid heel cup, firm midsole, straight last
  • High arches = need more shock absorption
    • Softer midsole, curved last
  1. General Guidelines for Footwear
  • “What shoe would you recommend? What’s your favorite brand?” There is NO cookie-cutter or “one-size-fits-all” type of shoe that works for everyone
  • The most expensive shoe does NOT equal the best quality!
  • Replace shoes every 3-4 months (OR approximately every 300-400 miles)
  • If running, alternate shoes every other day to prolong footwear life and reduce breakdown
  • Minimalist shoes are NOT for everyone (or anyone) 😉
  • Don’t follow the latest trends (minimalist shoes, zero-drop shoes, barefoot shoes)
  • Shoe manufacturers change/alter/update their models AT LEAST once a year, so get refitted EACH time you’re ready to purchase new shoes
  • Get fitted by a professional who analyzes gait pattern and finds a shoe that meets specific shape of foot and individual needs/goals
  • Many shoes these days have improved their arch support. You may or may not need to include over-the-counter arch supports. You don’t want to overcorrect your foot mechanics with too much medial arch support.
  1. Types of Shoes
  • Road-running shoesare designed for pavement and occasional forays onto packed surfaces with slight irregularities. They’re light and flexible, made to cushion or stabilize feet during repetitive strides on hard, even surfaces.
  • Trail-running shoesare designed for off-road routes with rocks, mud, roots or other obstacles. They are enhanced with aggressive tread for solid traction and fortified to offer stability, support and underfoot protection. Also great for hiking as alternative to hiking boots.
  • Cross-trainingshoes are designed for gym or Crossfit workouts or any balance activity in which more contact with the ground is preferred over a thick platform sole.
  • Neutral shoes:They can work for mild pronators, but are best for neutral runners or people who supinate (tent to roll outward). These shoes provide some shock absorption and some medial (arch-side) support.
    • Somesuper-cushioned shoes provide as much as 50 percent more cushioning than traditional shoes for even greater shock absorption.
  • Stability shoes:Good for runners who exhibit mild to moderate overpronation. They often include a firm “post” to reinforce the arch side of each midsole, an area highly impacted by overpronation.
  • Motion control shoes:Best for runners who exhibit moderate to severe overpronation, they offer features such as stiffer heels or a design built on straighter lasts to counter overpronation.
  • Barefoot shoes:Soles provide the bare minimum in protection from potential hazards on the ground. Many have no cushion in the heel pad and a very thin layer—as little as 3–4mm—of shoe between your skin and the ground.
    • All barefoot shoes feature a “zero drop” from heel to toe. (“Drop” is the difference between the height of the heel and the height of the toe.) This encourages a mid-foot or forefoot strike. Traditional running shoes, by contrast, feature a 10–12mm drop from the heel to the toe and offer more heel cushioning.
  • Minimalist shoes:These feature extremely lightweight construction, little to no arch support and a heel drop of about 4–8mm to encourage a natural running motion and a midfoot strike, yet still offer cushioning and flex.
    • Some minimalist styles may offer stability posting to help the overpronating runner transition to a barefoot running motion.

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