What is the Best Footwear?
As physical therapists, we are consistently asked this question. Truthfully, this should be evaluated on a case by case basis, but in this article we will talk a little bit about the positives and negatives of a few types of footwear, and how it can impact a variety of conditions as well as your body mechanics.
I want to start by saying that there is no one true ”bad” footwear. Are high heels or flip flops “good” for you? Definitely not, especially if worn at all times, but we know that they will be worn. As long as the proper time is spent outside of these shoes, accompanied with some ankle mobility work, you will more than likely come out unscathed. Variety is probably more important than sticking to one type of shoe. That being said, if you are not particularly good at standing on your toes all day, high heels will be a tough bet for you.
We are most definitely designed to be barefoot. It’s what our bodies have been accustomed to since the beginning of time. This is even true with sports and running. We did not have thickly cushioned shoes with anti-pronation control/arch support back when Pheidippides ran the first marathon. With all this said, barefoot footwear is probably not appropriate for a majority of today’s population due to us growing up in shoes/sneakers. With proper progression and strength training of the feet, you can help your overall health with transitioning to barefoot shoes for at least a portion of your day, even if it is just your gym workout or a short run. This can have great effects on the strength of your feet as well as improve the body’s ability to act as a natural “shock absorber” as opposed to adding foam to the mix. This can be super beneficial for patients with knee and lower back pain because it forces your calves and hips to absorb the extra force rather than somewhere else up your leg. The major drawbacks to barefoot/minimalist footwear is that you must have adequate ankle flexibility, and you must take proper time to get your feet used to high impact tasks without external cushioning. I would not advise this footwear choice for anyone with foot or hip conditions without special consideration.
Minimalist Footwear
Pros |
Cons |
|---|---|
|
- Strengthens Foot Muscles - Allows foot to move as it was designed to do - Can reduce impact on front of knees and low back - Improve calf strength - Allow toes to spread and reduce strain on bunions - Can be used only part of the time to improve strength |
- Initially requires a slow progression in order to avoid overuse injuries - Not appropriate for individuals with foot or ankle injuries - Not appropriate as main shoe choice for runners with a high training volume - Not the "quick fix" |
On the other end of the spectrum lies maximalist shoes. This is a relatively new type of product that offers external shock absorption as well as varying shapes and stiffnesses in the foot bed to alter how your foot moves. Sometimes more is better, and sometimes not. Keep in mind that we do use foam pads to train balance with patients, so performing an athletic activity or running in these shoes can have a negative effect. Your feet are designed to feel and interact with the ground, so more material separating that may not be appropriate. I would rarely recommend a true “maximalist” shoe to anyone as it does change the way your body is designed to work, but there are a few instances where it is applicable.
Temporary offloading with specific injuries
Hoka’s Meta-Rocker technology will decrease the strain on the big toe if painful/arthritic and may be beneficial in some cases
Hoka’s Meta-Rocker technology may also be beneficial in decreasing strain on the Achilles
Shoes with extra cushion + anti-pronation support may feel good for patients with highly sensitive heel pain.
I would not recommend long term use of these shoes for pain relief and would recommend a thorough medical examination to develop an active solution to ease pain and restore function.
Runners with a high training volume
You may get some offloading on the feet and lower extremities if you train hard and often. I would suggest this as more of a training aid as opposed to your new go-to shoe.
People who spend a lot of time on their feet and like the feel of extra cushioning
This is definitely not a must for people who work on their feet, but if you like cushioning, this type of footwear may be for you.
Maximalist Footwear
Pros |
Cons |
|---|---|
|
- Shock absorption for those who cannot absorb shock with their muscles - Specific shoe features may help offload certain foot and ankle injuries - Cushioning can be good for sensitive heel pain for short term relief - Help runners with high training volume give feet a relative rest |
- Will decrease strength of foot muscles if not strengthened outside of shoe - May not be good for an unstable/weak foot and ankle due since it is similar to standing on a pillow - Not appropriate for those without pain or high level runners |
The majority of sneakers on the market lie somewhere between the two aforementioned categories. Footwear probably has very little impact on your health if you do not already have some type of injury or are not using your shoes for a specific activity. If you are performing an athletic activity and are looking for a new shoe, talk to a professional such as a shoe fitter, podiatrist, or a physical therapist. There are a variety of factors that we look at to decide what would work best for you, including:
Ankle flexibility
Arch height
Arch flexibility
Calf strength
Foot strength
Big toe strength and mobility (its a bigger deal than you might think!)
Walking/running pattern
Single leg balance
Frequency and duration of desired activity
As you can see, there are a variety of factors that can affect the perfect shoe fit. If you already have a shoe that you like, stick with it! It is probably not worth making a change if you are already comfortable. A shoe in isolation WILL NOT fix an injury from running, unless the injury was caused by footwear. This being said, if it feels good, try it! If it does not feel good, the benefits are probably not so great that it is worth your dislike. Make sure to speak with a professional if you have any concerns about being in the wrong footwear. A good shoe or running store will be able to make a suggestion based on all of the factors surrounding your training.
Quick note: The amount of people who require arch support or anti-pronation support in their shoes is HIGHLY OVERESTIMATED. There is a naturally high variety of arch heights that more than likely have no effect on you foot, leg, or lower back health. Your best bet is to focus on the strength of your foot, ankle and leg as opposed to finding an external support that may not be effective and further weaken the stabilizing muscles in your foot.