A 50-year-old nurse was recently referred to me for nerve testing because of pain, burning, and tingling in her ankle and the sole of her left foot. The diagnosis turned out to be tarsal tunnel syndrome, a disorder similar to carpal tunnel syndrome in the wrist and hand. The suspected culprit? Almost certainly a fashionable new pair of bootlet-type shoes that pressed tightly against her inner ankle. Experiences such as this are one reason that, even though I’m a neurologist and not a podiatrist, one of the first questions I ask people with foot pain is whether they’ve bought new shoes lately.
A recent study from the Institute for Preventive Foot Health found that 78 percent of adults had experienced foot trouble at one time or another. Often the source of the problem is improperly fitting shoes. The biggest shoe mistakes I see: too tight, too high heeled, or too floppy. The good news, of course, is that those are easy problems to fix.
By far the most common problem is simply choosing the wrong size shoe. One study that actually measured people’s feet revealed that more than a third were wearing shoes that were either a half size too large or small; 12 percent were off by 1½ sizes or more! How does that happen? Your shoe size can change with age. As we get older, the soles of our feet lose padding, and ligaments and tendons lose elasticity and lengthen. Weight gain or pregnancy can also cause feet to widen. Experts have estimated that people over the age of 40 can actually gain half a shoe size every 10 years.
A study on footwear choices among older people found that eight out of 10 wore shoes that were narrower than their feet, and more than four out of 10 wore shoes with a smaller total area than their foot. Shoes that fit too loosely can also be problematic. They can create friction when feet slide around as you walk, and put you at an increased risk of tripping on carpets or stairs. Shoes with no backs at all, such as flip-flops and mules, can force you to take shorter, more irregular strides.
Even if the shoe fits, it can still hurt you. These styles are especially likely to cause foot pain.
Shoes with small or pointy toe boxes
They force your big toe inward and don’t leave enough room for your other toes. The most common consequence is a painful lump of bone on the inside of the foot called hallux valgus, better known as a bunion. The condition affects almost one in four adults, and if painful enough can require corrective surgery. Jammed against a tight toe box, the other four toes can develop a condition called hammer toes, a shortening of the first joint that causes each toe to curl down instead of lying flat—even when you’re barefoot.
High heels
They can cause the Achilles tendon in the ankle to contract and shorten, which can cause plantar fasciitis (an inflammation of the soles), and cause neuromas, painful nerve growths on the ball of the foot.
Thin soles
Ballet flats and other shoes with little padding can also cause plantar fasciitis because the lack of proper cushioning can inflame the balls of your feet.
To avoid shoe-induced foot problems, get the right fit in the first place. Measure your feet regularly. The best time is at the end of the day when they have expanded to the max. Other tips to consider:
Try shoes on both of your feet. Most of us have one foot that is larger than the other. Your shoes should fit the larger foot.
Stay away from shoes with narrow toe boxes. That’s especially true if you have already started to develop bunions or hammer toes.
Be careful when buying shoes online. If in doubt, order shoes in more than one size. Many companies offer free returns, so your only investment is the time it takes to drop your rejects into the mail.
Go low with heels. Stick to heels that are 2½ inches or lower. If you like to wear higher heels for special occasions, bring them to the event in a bag, put them on at the door, and remove them the minute you leave.
This article also appeared in the February 2014 issue of Consumer Reports on Health. Read more columns from Dr. Avitzur.
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