Many people out there have jobs that require long hours on hard floors, and their feet suffer for it. In the next two posts, I want to discuss some tips on how shield the feet from the strain that those long hours can inflict on them, and how appropriate shoes and inserts can help make a difference. I am splitting it up because the topic is so broad, but it is important to discuss.
The feet can withstand many hours of activity, but unfortunately we are not necessarily genetically predisposed to being able to withstand flat, hard surfaces for long hours. In that regard, our feet need help, and that help comes in the form of shoes and sometimes inserts that go into the shoes to provide support, comfort, and foot endurance. Shoe choices are influenced from a number of different factors, ranging from fashion to employer mandate. People select their shoes for both personal and professional reasons, but do not always make the best choices and have to suffer the consequences. Unfortunately, there is not one or even several specific shoes or even shoe styles that are best for the human foot. Everyone has different structural needs that are influenced by the direct structure and shape of one’s foot, their body weight, their activity level, and the surface they walk on. All these factors make for a very confusing picture in respect to selecting a good shoe, but there are a few ways around this.
The first place to start is with one’s foot ‘structure’. Foot structure simply refers to what shape of foot one has in relationship to the ground. Some people have flat feet, some have high arches, and some are in between. Those with very flat feet and high arches will be able to easily see what their structure is when they stand. Those who have more subtle forms of either one of those structures may not be able to necessarily appreciate that when looking at their feet when standing, and may assume they have a ‘normal’ foot structure. This is because many of those changes are hard to externally see, but a biomechanical exam by a podiatrist and/or an x-ray of the foot taken standing will show the true structure. The foot’s position, incidentally, when one is seated, gives a false picture as most of the structural changes of the foot occur during standing, except for those with severe and rigidly flat feet that can be seen when seated.
Once foot structure can be determined, a few rules can be applied to shoe selection. In general, those with flat feet need shoes that are more structurally stable. This kind of shoe is more rigid across the bottom, and should only bend in the part of the shoe where the ball of the foot rests, not the middle of the shoe. The shoe should also not be ‘twistable’ like a towel- it should resist attempts to twist it around. These areas of firmness can help resist the arch collapse seen in flatter feet. The area on the back of the heel should also be firm, and resists efforts to push it in so that it can more firmly cradle the more flexible heel area a person with a flatter foot has. The bottom of the shoe should also be wide, hourglass shaped soles are not helpful for flat feet as the foot will spill over the narrow part of the sole. Obviously, all these components work best in an enclosed oxford style shoe, or more ideally an athletic shoe. Other shoe types can provide some elements of this support, including newer forms of sandals that are designed with firmer arch beds that cradle the arch better. Shoes that are to be avoided in this category are flip flop sandals, flimsy cloth or canvas shoes, and most types of women’s flats. High arched feet, on the other hand, need much more cushioning, as they cannot absorb the shock generated by the ground contact when walking (something done when the foot is able to normally flatten more). The shoe for a high arched foot needs to have a nicely cushioned sole, usually with greater thickness, to displace the shock away from the foot. It should also be deeper to accommodate for the greater depth a high arched foot has within a shoe. These characteristics are relatively easy to achieve in an athletic shoe, but are harder to find in a dressier style. When selecting a dressier style of shoe for high arches, one has to more seriously consider the thickness of the sole material, as well as the softness of the material. It should be a denser rubber or foam composite material, and should be stable as well. People who have feet that fall in somewhere between flat and high arched should use a stable shoe similar to what one would wear if they were flat footed, as a stable shoe will provide better protection against foot fatigue over the course of a long day standing on hard surfaces.
The next thing to consider when trying to keep one’s feet comfortable all day is the need for inserts into the shoes. Shoes alone can make a big difference in general foot comfort, but rarely do they actually contact the foot to the same degree that an insert in the shoe will. Selecting an insert is a relatively simple process. People with very flat feet generally need a rigid custom made orthotic to stabilize the arch and keep the foot from fatiguing after standing all day. People with more moderate flat feet can benefit from either a custom orthotic or a semi-rigid over-the-counter insert like Footsteps or Powerstep Pro. Those with high arches benefit from either a well padded custom orthotic or a well padded over-the-counter insert, of which there are multiple brands. Those who have foot structures in between can benefit from over-the-counter inserts in general. I do recommend that my patients avoid hard plastic inserts from retail insert stores, as these hard inserts are not made specifically for a single foot like hard custom orthotics. Because of this, they may eventually irritate the foot more than they help as the ridges of the arch will not match the foot shape exactly. Given the excessively high price one usually pays for the inserts in these stores, a custom orthotic can be manufactured, often for the same or less. I also recommend that thin inserts like flat gel or foam inserts not be used for support or shock absorption, as they easily compress down to nothing when stepped on, and essentially are only a replacement for the sock liner padding that already comes in the shoe.
One other factor that needs to be considered is one’s bodyweight. For many, this is a sensitive topic, but it does have a factor in general foot comfort by the end of the day. Obviously, people who are of normal weight or mildly overweight do not need to consider their weight in selecting shoes. Those who are very overweight or obese do have to consider their weight. In cases of very heavy bodyweight, regardless of the foot structure, the shoes that one chooses needs to be very stable, with strong rigid material in the sole to help resist the pressure on the foot from the bodyweight. Inserts in the shoes that provide additional rigid support are also very helpful in stabilizing the feet and improving comfort throughout the day.
I will continue this discussion next post, where I will discuss what role activity level and walking surfaces actually have on the feet and the life of the shoe, and whether some foot discomfort needs additional treatment beyond simply good shoes and inserts.
Scott R. Kilberg DPM 