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feeling fine

Finding the footwear that fits your needs

iStockphoto.com

iStockphoto.com

I have rolled my ankle more than once while wearing Dansko clogs. And yet, as soon as one pair wears out, I buy another. • Putting aside the risk of injury for a minute, I do find my clogs comfortable. Indeed, they are marketed as foot-healthy comfort shoes. These particular clogs are shoes of choice for many people whose jobs involve lots of standing, such as nurses and chefs. • But are comfort shoes always more healthful? Not necessarily, according to some foot doctors. • Buying shoes from a store specializing in comfort shoes doesn't guarantee that they will be comfortable or good for you. • What makes a shoe a "comfort shoe"? Generally speaking, it means cushioning under the foot and supportive features such as arch support. Birkenstock sandals, another comfort line, have a molded foot bed with an indented heel cup and a bump under the forefoot — the metatarsal pad, which deflects pressure away from the ball of the foot. "They're a really comfortable choice for many people," says Erika Schwartz, a podiatrist with DC Foot and Ankle in Washington. • But for others, not so much.

A shoe that fits

A small study of people with osteoarthritis of the knee found that walking in clogs and so-called stability shoes was harder on the knees than walking barefoot or in flip-flops. This suggests that certain supportive shoes can alter your gait in a way that's unhealthy for joints above the ankle, at least temporarily and in people with arthritis.

"What are the best shoes to wear? I hear this question 20 times a day," says Selene Parekh, an orthopedic surgeon at Duke University Health System.

Parekh says to look for a shoe that's supportive and comfortable — for you. That may not mean spending nearly $200 on a pair of loafers marketed to fit what one shoemaker calls the "anatomical footbed."

The way you walk

If you are having foot problems, the best thing to do is figure out the type of foot you have and how you walk. Do you pronate — rotate your foot so that the inner edge of the sole bears the bulk of your weight? How high or how flat are your arches?

When a patient comes in with foot pain, Parekh looks at the wear pattern on her shoes. If the inner part of the sole is worn, he'll look for flat feet overloading that area. Outer-sole wear may indicate high arches. More wear on the heel or under the ball of the foot can show whether a person is a heel-striker or a forefoot-striker when he walks.

These wear patterns are not problems in and of themselves. "If you don't have pain, your walking pattern is fine," Parekh says.

If you do have pain, a foot expert — either a foot and ankle orthopedic surgeon or a podiatrist — can help you understand shoe features to look for and to avoid.

Foot experts recommend shopping at shoe stores with experienced staff who take the time to do a good fitting. Schwartz sends her patients to high-end running shoe stores with a description of what to look for and what to avoid.

Arches and ankles

People with high arches (like me) are more likely than flat-foot types to roll an ankle in clogs, Schwartz says. That's because arch height can affect which part of your foot bears the most weight as you walk.

Properly aligned ankles sit directly over the heels. Feet are pronated when the heels tilt out from the body and the ankles roll in — picture young children on ice skates — a characteristic that is often linked to flat feet. When heels tilt in and the ankles roll out, the feet are supinated; this often occurs with very high arches.

An orthotic insert that raise the outer edge of the foot can help stabilize a supinated foot within the clog, Schwartz says. (Pronated feet can benefit from arch supports.)

Orthotic inserts are designed to correct the alignment of the foot and ankle, which helps maintain proper positioning of the knees and hips and even the lower back.

A 2008 review of research on easing foot pain found one small study in which custom orthotics helped people with high-arch, supinated feet. For other conditions, such as bunions and plantar fasciitis, the evidence was equivocal.

"In my experience, cheap orthotics really work just as well as custom-made ones for the most common problems," says Katherine Margo, a family physician at the University of Pennsylvania.

A minimalist proposition

What about minimalist shoes, designed to honor the form and function of the foot? They are the antithesis of the comfort shoe: Advocates say that cushioned supportive shoes encourage runners to land on their heels, which can lead to bad form and chronic injury.

However, minimalist shoes are not right for everyone. "We've seen enough patients with Achilles tendon issues and stress fractures from running in these," podiatrist Ericka Schwartz says.

Their use for walking and standing has not been nearly as well studied.

Finding the footwear that fits your needs 01/22/14 [Last modified: Wednesday, January 22, 2014 2:41pm]
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