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    Finding Your Footing in the Wide World of Footwear

    Finding Your Footing in the Wide World of Footwear

    Good health requires us to practice moderation in many areas, from what we eat to how much sleep we get. Too much can be just as detrimental to our health and productivity as too little. Back and foot health is similar, according to research. Studies published recently reported that though sedentary lifestyles have caused a rise in high blood pressure and heart disease, the other end of the spectrum can be just as problematic. Individuals that spend most of their day on their feet – including people working in the health care, restaurant, education, industrial, retail, postal, and construction industries – are at increased risk for debilitating back, muscle, spinal, foot, and joint pain. One of the easiest and most often overlooked preventative measures people can take in striving to maintain back and foot health is wearing good shoes that fit well and provide adequate support.

    Is standing still really a big deal?

    Prolonged standing has the potential to cause chronic foot pain, blisters, rough and painful callouses, bunions, corns, and misalignment of the spine, hips, and knees. In addition, on-the-job standing may have deeper social and economic implications. Maria Gabriela Garcia, medical researcher, recently spoke out in an interview with Human Factors saying, “Work-related musculoskeletal implications that can be caused by prolonged standing are a burden not only for workers but also for companies and society. Long-term fatigue after prolonged standing work may be present without being perceived.” Garcia asserts that employees required to stand for prolonged stretches will become less productive and more fatigued over time. She also suggests that the medical costs and sick-leave requests to companies that require prolonged standing is higher than it would be otherwise. This burden on the company and decrease in employee productivity and health is detrimental to the economy and an individual’s ability to contribute to society overall.

    The risks of prolonged standing are so well-researched and documented that the United States Department of Labor, United States Department of Labor Occupational Safety and Health Administration (OSHA) published employer regulations and preventative measures that should be taken to avoid damage caused by prolonged standing. OSHA reports that prolonged standing can be a major risk factor in the development musculoskeletal disorders (MSDs). According to OSHA, musculoskeletal disorders are the “most frequently reported causes of lost or restricted work time….[and] accounted for 33% of all worker injury and illness cases.”

    How can I avoid injury or damage from prolonged standing?

    In a perfect world, we would all work at jobs that allow us to sit down periodically through the break to recharge physically, mentally, and emotionally. Unfortunately, for many workers around the world, this is not the case. If you’re working at your first job that requires prolonged standing, you can expect foot pain, blistering, and lower back pain for the first week or two. In fact, it may take up to a month before your body is fully able to adjust.

    Additionally, the body has to work harder to support excess body weight. Overweight individuals may be able to relieve pain and prevent further injury or damage from prolonged standing by losing weight if recommended by a medical professional.

    If the company dress code allows individuals to wear sneakers, this is usually a better decision than wearing dress shoes or fashion footwear. In fact, if not limited by a company dress code, one of the healthiest footwear decisions for most people would be an athletic shoe with a shank. The shank of a shoe functions to stiffen the middle part of the shoe, allowing the shoe to resist twisting or excess tension, and assisting the shoe in bending natural at the toe as opposed to folding at the arch.

    Better than focusing on a particular shoe, according to the official stance of the American Association of Podiatric Sports Medicine, is understanding the parts that make up a shoe and determining what shoe features are most important for your needs. The important aspects of shoe construction to understand include: heel height, toe box, closure, shoe material, arch support, soles / outsoles, and shoe weight. Heel height

    Heel Height: How high is too high?

    Human movement supporter and accredited podiatrist, Dr. Emily Splichal suggests that people never wear shoes with heels higher than 3 inches at the most. She explains that any heel higher would alter your body’s movement and walk in that you’ll take shorter strides, shift body weight primarily to the balls of the feet, slow your walking pace unnaturally, add stress to your knees, increase tension in your lower back, and alter your body’s center of gravity. Altering the body’s center of gravity makes an individual more prone to accidents and causes chronic lower back issues as the body attempts to maintain stability when standing and walking. Shoes with higher heel height also encourage people to walk with more force and pressure on the heel with each step, also known as heel striking. She reports that having a smaller heel, approximately 1 – 1  inches high, is a more beneficial height for foot stability.

    Jay Dicharry, Master of physical therapy and gait and injury expert, recommends that people consider zero-drop shoes when looking for heel height that will alleviate some of the foot and back pressure from prolonged standing, though his opinion is highly controversial in the footwear community. Zero-drop shoes allow for the foot to remain in a natural, near-parallel relation to the ground at approximately 0-4 mm of drop from heel to toe. Average shoes generally have a 4-10 mm heal to toe drop, which forces the body to adapt to the center of gravity change.

    Unfortunately, zero-drop shoes can cause foot and tendon soreness and injury for many people and require all people to transition to zero-drop position to avoid bodily harm. When considering zero-drop shoes, it is best to consult a medical professional.

    Time to talk about toe boxes.

    Podiatrists agree that having a roomy toe box, or front shoe area for the toes, is important. Most shoes popular on the market are not shaped like feet and will not promote good health and movement. The toe box should be wider than the area for the ball of the foot, allowing the toes to move and adjust even when the shoe is being worn. Having pointed shoes or shoes without an adequate toe box has been shown to cause bunions, which is swelling of the joint of the first toe, and nerve damage over time. Wearing shoes that squish the toes can permanently (and painfully) alter the shape of the foot, making it harder to find shoes in the future.

    Robyn Hughes, ND has been an advocate for natural toe box shape for years. She asserts that shoes with a narrowed, or tapered, toe box can cause blisters (which may lead to infection), corns, calluses, crooked toes, runner’s knee, shin splints, sesamoiditis (pain due to fracture of the toe bones), fungal / ingrown toenails, hammertoes, foot / leg tendon issues, plantar fasciosis (pain and swelling of the underfoot tissue that connects your heels to your toes) in addition to bunions and bunionettes. Hughes says that the “toe box taper is the principle underlying cause of these conditions, but few healthcare professionals educate their patients about the hazards of this common shoe design feature.” Hughes further explains that the foot / back issues we see due to shoe design flaws are not seen in cultures that spend more time sitting or barefoot. In fact, even our ancestors had a leg-up on foot health before the widespread use of concrete and pavement in the construction of cities and workplaces; our feet and toes contain bones not able to cope with constant intense shock from hitting hard surfaces without adequate protection and support. 

    While having a wide enough toe box to comfortably fit your toes is important, it is also crucial to make sure the space in the toe box is not excessive. Having too much space in the front of the shoe can cause the foot to rub and bang against the shoe all day, causing pain and blisters. In addition, shoes with toe boxes too large for your foot will also lack the stability and arch support your foot needs to maintain optimal balance and functionality.

    Closure: The battle between laces and Velcro is one of customization versus convenience.

    Rob Conenello, DPM, licensed podiatrist that served as past president of the American Academy of Podiatric Sports Medicine, believes that when it comes to laces or Velcro shoe closures, “you want a shoe that is going to optimize performance, so the closure should enhance the shoe’s fit and function”. Conenello recommends laces over less-traditional closure methods such as Velcro because these methods don’t “provide the form-fitting feel that you get from going eyelet to eyelet with traditional laces”. Essentially, laces allow for shoe customization.

    Conenello and other podiatrists encourage people to use heel-lock modification as needed to ensure appropriate shoe closure. Heel-lock modification refers to threading shoe laces through the top two eyelet holes to prevent the shoe from slipping around on the foot while walking. He stresses that the goal of shoe fit is achieving a “neat fit” of the shoe, meaning that the shoe is closed snugly enough to remain in place but not so tight that blood flow is constricted or the foot is unnaturally squashed.

    Kevin Fraser, podiatrist and president of the Pedorthic Association of Canada in Winnipeg, explained, “With a lace shoe, you can control the pressure over the foot better than you can a shoe with one or two Velcro strap because you can tighten or loosen the laces…You also have more options in the way you thread and tie the laces.”

    Eyelets, or the hole through which the laces are threaded, are also important to consider when shoe shopping. It is important to avoid hooked eyelets if you do not have a Kevlar or waxed lace because the actual eyelet will be torn and shredded quickly, making the shoe more difficult to fit properly.

    Nearly as popular and customizable as laced shoe closures are monk-strap or buckle shoes. Monk-strap shoes require no lacing but allow for neat fit through the use of a buckle and strap.

    Many considerations for materials and features.

    You should carefully consider if the materials used to produce a shoe will meet your needs. The material of a shoe will determine durability and longevity, as well as if the shoe holds its shape. Leather shoes, for example, will mushroom out with the degree of change depending on the type of leather and which chemicals were used to treat it. 

    You should also avoid adding additional treatments to the shoe before considering the indirect consequences of those changes. If you purchase a pair of waterproof boots or shoes, you should not double up on that treatment by adding additional coats of waterproofing chemicals because that will decrease the breathability of the shoe. Instead, to preserve the features and functionality of the shoe, you should wait to re-apply waterproof material when the original fails.

    Adequate breathability, flexibility, and stability are necessary and vary depending on the purpose of the shoe. If you’re not sure what the best option is for you, it’s wise to consult a professional.

    Arch Support: The foundation of foot health.

    Your arches allow your foot to support the weight of your body with the least amount of effort, absorbing pressure and shock as you walk and run. Everyone’s arches vary but fall into three main categories overall: low arch (flat feet), medium / neutral arch (approximately 60% of the population), or high arch (approximately 20% of the population). Not everyone needs to worry about arch support, and for people with a neutral stance, adding extra arch support can potentially do more harm than good, causing supination (foot rolling outwards with each step) and contorting the foot into an unnatural shape. Arch support is crucial, however, for people with low arches. People with flat feet experience over-pronation when they walk, which means that the foot rolls excessively inwards. This misalignment of the skeletal system puts pressure on the ankles, knees, and hips which can cause chronic pain. Similar to those born with flat feet, the arch naturally collapses over time, meaning people generally need more arch support as they age.

    The use of prosthetics, or insoles / orthotics, can provide the opportunity to give our feet the extra arch support needed for a healthy stance and gait. Using orthotics can help dramatically with providing overall comfort and avoiding or decreasing foot pain. Over-the-counter orthotics such as Superfeet and Spenco are affordable ($25 - $100) compared to custom-fabricated insoles, which often cost $500 or more and require a professional to reproduce once worn out. Using over-the-counter orthotics can not only remedy back, knee, and hip pain but also extends the life of shoes dramatically, as the insoles can be replaced once worn out without requiring the purchase of new shoes.

    Inside insoles and outsoles:

    Outsoles differ from insoles because outsoles are the material on the bottom of the shoe on the outside while insoles, commonly referred to simply as soles, are the bottom of the inside of the shoe that touches the sock / foot. Noting the material of an outsole is important, as is determining the grip provided by the outsole, because you’ll need to make sure the outsole meets your needs in terms of traction and durability.

    In general, it’s better not to purchase shoes with too much built-in cushion on the bottom and sides inside of the shoe because this will, in time, wear out if the shoes are being used on a regular basis. It’s a much more fiscally-efficient idea to simply plan to purchase orthotics, trim the purchased orthotic to match the factory insole, replace the factory insole with the orthotic, and repeat the process whenever the orthotic is worn out. 

    When looking at various soles, it is crucial to determine what qualities are important for you. For work shoes, you’ll need to remember that certain designs and materials grip better on different surfaces. For example, a kitchen worker would likely seek out shoes capable of gripping well on grease or spillage while a roofer may be more interested in footwear that can grip on ice. When in doubt, it’s a good idea to consult an expert at a specialty store or an individual with experience purchasing shoes for your needs.  

    It’s also important that the soles of the shoes are thick enough for your needs. Construction workers will need boots that can protect them if they step on a nail while a teacher may not need to be as concerned about sharp objects. 

    You can gather information about the right outsoles for you by noticing the wear patterns on the bottom of your current shoes. It will be important to pick shoes with outsoles that provide support in the areas that seem the most worn on the bottom of your current shoe. When trying on a pair of shoes, you can test the soles by walking on hard and soft surfaces and testing the shock absorbance of the shoes before purchasing them.

    Weighing-in on shoe weight.

    The weight of a shoe is determined by the materials used to produce the footwear and the construction of those materials. The  American Orthopaedic Foot and Ankle Society stresses the importance of considering the purpose of the shoe when assessing shoe weight. Shoes made of heavy, durable, thick materials or with large toe boxes are likely going to be heavier and less breathable than shoes designed for fast movement with minimal materials.

    Hallmark of good fit:

    - The ball of your foot fits comfortably into the widest part of the shoe.

    - The shoe bends naturally with the foot, at the joint of the toes.

    - Your longest toe (not necessarily big toe) should be a thumb's width from the toe of the shoe. If you're unsure if the shoes are long enough, try kicking the floor or the wall. If you feel the impact of the kick on your toe, it would likely be best to go up a size.

    Anticipate investing in quality and protecting your investment!

    Because most people spend at least a third of their day on their feet, with individuals in prolonged standing jobs facing long shifts without being able to sit, footwear is not the area to look to save a few bucks! An investment in quality footwear is an investment in your health and will pay off in the long-term in the form of fewer back, knee, hip, ankle, and foot issues (and less time away from work for these problems). Using orthotics, as previously described, can help drastically increase the lifespan of quality footwear. Likewise, having two pairs of shoes to rotate will make them last longer, especially if you work in hot or moist environment. Shoes need time to dry between uses to avoid the growth of mold or fungus, the development of odor, and the formation of blisters on the feet. Moisture-wicking socks made of smart-wool, merino wool socks, bamboo socks, and synthetic socks with coolmax fiber will also prolong the life of your shoes by preventing the build-up of moisture. 

    Successful Shoe Shopping:

    So, now that you know what to look for in a good shoe, you’re ready to go out and find your footwear! It’s a good idea to seek professional help if you’ve never focused on purchasing shoes for good health. Sales representatives at specialty athletic / running shoe stores can provide the knowledge and expertise you may need to pick your perfect pair. In fact, REI employees can even fit and trim insoles for you upon request!

    Shoe experts found in specialty stores may also be able to offer specific information on brands of shoes, shoe materials, and functionality of shoes for your needs. If you’ve never had your foot professionally measured, this process can help to make buying well-fitting shoes faster and easier. Another popular alternative is to trace the outline of your foot before shopping to use for size comparison once you’re in the store.

    Shoe shopping is best done in the afternoon or evening after a long day because the foot naturally swells as the day passes. You’ll get your truest fit after a long day of work. You’ll also want to make sure to wear the same socks you would wear with the shoe being purchased. If your dress code requires you to wear professional, thin, nylon socks, the fit of a shoe will be looser than if you were wearing flannel socks; if you need to, bring an extra pair of socks to use for trying shoes on in the store. Use caution if you try on shoes with a pair of socks provided by the shoe store. These socks will generally not be the same size or thickness as the socks you’d normally wear, and this can give you an inaccurate fit.

    The American Podiatric Medical Association provides consumers with a database of information on products and companies that have been awarded the organization’s seal of approval / acceptance for promoting foot health and following best practices known to the podiatric community. You can use the database to research both companies and products that prioritize good foot health.

    Remember that the purpose of shoes is to support the natural function of the feet. The best shoes provide adequate support in a natural shape that bends in the same way that your foot does; shock is absorbed, stance is optimized, skeletal system is supported, and gait is energy-efficient. Finding the right pair of shoes for you may be slightly more time-consuming and costly than throwing on the first pair you can find at a local store, but you definitely get what you pay for with your time and money! 

    Your ability to function at your job, with as little pain and fatigue as possible, depends greatly on your choice in footwear. Your shoes also determine the severity of skeletal and foot / ankle issues in your future, potentially saving you from years of chronic pain after retirement. Making good footwear choices now will certainly pay off for years to come.

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