What does a good shoe look like? How do I know I am buying the best shoe for my feet? As a practicing Physical Therapist, these are the type of questions I have needed to answer for my patients over the years. One of the most significant areas of focus for me has been the care and treatment of the feet. This area of the body is often overlooked in its importance of lower body function and their impact on the leg joints and spine. This study of body function is typically known as "biomechanics", which is the evaluation of the structure, function and motion of the body. In the context of this article, we will focus on the lower quarter of the body, which includes the feet, knees, hips, and spine. Support of the feet becomes paramount when you consider the impact of forces that enter through the feet with each step and are translated up the joints of the ankles, knees, hips and finally the spine. In the physical therapy industry this is called the Kinetic Chain. Basically, it is the collective chain reaction of forces that occur in the lower quarter of the body. With each step kinetic forces enter the foot and impact leg, hip and muscles of the lower back primarily the iliopsoas or hip flexor. This muscle is so important because it ties the function of the foot and leg muscle with the joints of the lumbar spine. One could even call it the leg-back connection muscle. We could use the analogy of the body to that of a car or vehicle. The car, has struts or shocks, tire pressure, joints and a chassey that allow for proper mechanical motion and function while traveling at any given speed. In the human body, the struts are the arches of our feet, which function to provide shock absorption with each step. The faster we walk or run, the more shock absorption or stability is needed. The joints of the body, would be just that; the ankle joints, knee joints, hip joints and spinal joints which are on the receiving end of those impacting forces. The tire pressure of the human body could be analogous to the condition of our shoes. The chassis, would be analogous to the spine. This is where we would apply the importance of alignment. In taking care of our cars, we typically make sure our struts or shocks are in good order, our tire pressure is adequate to keep the joints functioning and supported. All of these impact the chassis and its alignment. In our bodies the chassis is collectively the spine. And just like the chassis of a car it is alignment is subject to the supporting structures below it. It seems as though the engineers of the automobile industry may have used the human body to design the function of cars. Would you drive your car from Denver to Vail Colorado (approximately 80 miles) with worn out tires or a broken strut? Of course not! This would likely have a negative impact on the cars alignment. So, I believe we should consider our choices in shoes as they pertain to the impact on our knees, hips and spinal alignment.
So how do we choose a shoe that best fits and supports our need for adequate shock absorption and/or support? This question could be answered in a number of ways depending on who you ask and their education or background. However, I will tell you, that in the 42 years of practicing physical therapy, I have found the most consistent way of determining a proper shoe type is to know what type of foot you have. Most athletic shoe brands will make a variety of styles labeling them as running shoes, cross-trainers, court shoes and the like. Nike has typically sold very flexible shoes for running, but now sells the Air Max which has a much more rigid shoe base. Most major shoe brands have created a spectrum of flexibilities from which the buyer can choose. But how do you make this choice and what do you base it on? After reading this article you will see that the brand or style you choose isn’t as important as the flexibility of the sole of the shoe you will need.
For the past 22 years I have been using a foot flexibility test called the GIB test, created by Gib Willet, while he was a Professor of Biomechanics at the University of Nebraska Medical Center. This test is a way of classifying the foot into a category 1-5 of flexibility. The numbers 1,2,3 indicate a more flexible foot type. The numbers 4,5 indicate a more rigid foot type. Once you know your foot type you can target your shoe choices. This test is typically done by a trained health practitioner, a Doctor of Physical Therapy, Podiatrist or Chiropractor. This test can be used to determine proper orthotic fabrication as with Sole Supports Orthotics, developed by Ed Glaser, DPM or can be used to help determine the best shoe for support depending on your score. If you score on the more flexible side of the test, 1, 2 or 3 you would typically require a more rigid shoe to give more stability to the flexible foot. If you score a 4 or 5 you would look for a more flexible shoe to give your feet more cushion and shock absorption. In either case, the person would need to hold the shoe strings floor-facing, one hand at the heel and the other hand at the forefoot (toe end) of the shoe, testing the “bend” or flexibility from the forefoot. The greater the rigidity of the shoe’s forefoot, the better the stability for someone with a flexible foot type. The less rigidity of the shoe’s forefoot, the better the shock absorption for someone with a rigid foot. Next, after determining the general flexibility of the shoe, try at least 3 pairs on that are similar to “let your feet pick” which ones feel the best. Take the time to walk around the store before you make a choice, this will give you a better feel for the shoes. When a shoe is the right one, “your feet will know it.”
So, whether you are choosing a shoe for running, cross-training or playing tennis, you want to purchase one with the correct flexibility for your foot type. By choosing the correct flexibility in a shoe you are providing a better more supportive foundation for the joints of the body beginning at the feet which are the first point of contact with the floor or surface you are on. One shoe of note, the Hoka, has gained great popularity over time. This shoe can be worn comfortably by people with either foot type because of its unique design in “rocking” the foot forward more quickly into the Doris-flexion phase to prepare for heel strike. This shoe may not be for everyone and must be tried out by the buyer like most other shoes to determine if it is a good option for the sport of your choice.
In the case of motion controlled shoes, how do you know how much control is needed? The truth is, you don’t know. And shoe makers of this type of shoe cannot customize the type of control needed for the thousands of people out there buying any of these types of shoes. It is not a one control fits all. This can only be achieved with a custom arch support. It is important to remember that your foot type is a condition of heredity, it is neither good or bad. Because your foot type is inherited you can’t change it, so the goal is to support what you have.
Although it is best to have a skilled or trained professional evaluate your foot type you can make an educated guess by looking at the wear pattern of the soles of your shoes. In general, if you have a wear pattern towards the inside of your shoes, your foot is likely to be more flexible, therefore you would look for a more rigid shoe. If your wear pattern is in the middle or outside of your sole, you would tend toward a more rigid foot, and a softer, more cushioned shoe would be the best choice.
By choosing your shoes in this way, your overall comfort level of your feet, leg joints should improve.
I must emphasize that shoe flexibility and arch support are two different issues. No shoe is designed to give you arch support because this must be customized to the persons foot type, body weight, and specific calibrations performed by a trained professional. Proper support of the arches requires a professional assessment and custom casting to provide and insert in the shoe that re-postures the arches over time. True arch support or lift improves the function of the arch by preventing full collapse (over-pronation) during the weight-bearing phase of each foot.
There are many brands of orthotics out there with varying degrees of efficacy. In my current Physical Therapy practice we use Sole Supports Orthotics for casting and dispensing because they have given the most significant improvement of foot and lower quarter pain as well as in patient function and return to sport. I have used this brand since 2001 and found them to provide the most consistent in overall improvement and patient satisfaction. These are medical grade orthotics and have a unique design based on the MASS posture theory (Maximal Arch Supination Stabilization) developed by Ed Glaser, DPM. as a credible way of controlling over pronation, (see Foot posture and Biomechanics MASS theory, published in the Foot and Ankle online Journal). Dr. Glaser has done a great deal of research in the design and function of a custom corrective orthotic.
If you suffer with chronic foot, knee or lower back pain, these are signs that you have biomechanical issues that need correcting at the level of the arches and a trial of physical therapy may be necessary to alleviate the pain and inflammation. Physical Therapy treatment should not be over-looked as it can prevent long term chronic pain and joint deterioration if addressed early on in symptom onset. There are many forms of pain therapies available for relief of lower quarter pain via Physical therapist: these include but are not limited to, Integrative Dry needling, instrument assisted manual therapy, shock wave, micro current therapy, infrared therapy, manual therapy, and of course evaluation and dispensing of custom orthotics. There is a relatively new technique that I have had personal success in gaining relief from pain called, Relax, Relief, Release as described and taught by Dr Ed Glaser.
More information on custom orthotics as well as the Relax, Relief, Restore pain relieving treatment can be found at solesupports.com.
I hope this article gives some insight as to these industry concepts that use daily in assessing treatment options, that are generally unknown to the public. I believe that as a lay person, knowing this information can give you more success in choosing your shoes to better fit your biomechanical needs. This article may get your head churning with questions. If so, contact a Physical therapist as they are trained to look at the entire picture of your mechanical function. If they have training in treating the feet and GIB testing, you will do even better in achieving long term results.
Written by: Shari Ritzmann, PT