We are all aware that our footwear can have a huge impact on our foot health, but what exactly makes flat footwear bad for our feet and can they contribute to foot pain? The long term impact your footwear can have on your feet can include; foot pain, structural damage to the foot and ankle, corns and callus and many other issues and pathologies further up the chain. With so many different selections of shoes to choose from, it can be difficult to ensure you are making the right decision specifically for your feet. No matter what your job or your daily activity looks like, your footwear is crucial for the care of your feet.
We will explore “flat shoes” and the impact that they may have on your feet over time, as well as briefly touch on what to look for in a good, supportive shoe.
What exactly is a flat shoe?
A flat shoe refers to a style of shoe that is flat through the midfoot or the innersole of the shoe – This means it has no support in the arch of the shoe (the sole of the shoe does not contour your arch). It may also include shoes that have no heel to toe drop (HTT drop). This may include casual flats, womens dress/ballet flats or thongs (flip flops). In some cases flat shoes may be okay, but we recommend that you only wear your flat shoes on occasions, as daily use may lead to various foot, ankle, lower limb and other pathologies.
What are the risks of wearing flat shoes?
There are many risks or pathologies that come with wearing flat shoes over a long period of time, here we will explore each of them. Some of the risks associated with wearing flat shoes include;
Joint impact – Due to the lack of cushioning and support in flat shoes, there is a large amount of impact going through the structures and specifically the joints of the foot. Over time this can lead to damage to the joint and subsequent pain. Impact in the joints happens with jumping and other fast movements, but can also occur just with walking. The impact going through the joints can be reduced with more appropriate footwear, for example a shoe with cushioning and arch support.
Ankle injuries – While footwear does not necessarily prevent ankle injuries, flat shoes can put you at a higher risk of ankle sprain or soft tissue inflammation and pain. Most flat shoes do not provide support around the ankle and therefore leave the ankle vulnerable to lateral movement. Heeled shoes can also put the foot at risk of ankle sprains.
Plantar fasciitis – The plantar fascia is a band of fibrous tissue (fascia) that inserts at the inside of the heel bone and attaches to the heads of the metatarsal (toe) bones. It is essentially responsible for the arch of the foot. During gait, we generally push off through the first toe, which triggers what’s called the windlass mechanism. The windlass mechanism ultimately means that the heel is brought closer to the forefoot and therefore acts as a lever during propulsion. This means that the plantar fascia is responsible for a great amount of our load during gait. Without the arch support in a good shoe, we are placing more load on the plantar fascia and therefore placing ourselves at risk of a condition called plantar fasciitis. While there are usually a great number of contributing factors to a condition like plantar fasciitis, a lack of supportive footwear has been proven to be one of the consistent risk factors.
Achilles tendinopathy – Flat shoes can also contribute to achilles tendinopathy. The lack of support through the arch of the foot may lead to flattening or a pronatory force through the foot, which can begin to place a further load on the achilles tendon and the calf muscles. Shoes that have a heel to toe drop (of ideally 10mm) and provide arch support are recommended for people suffering achilles tendinopathy. Another consideration is that high heels or heeled boots, when worn for long periods of time, can actually shorten the calf muscles and therefore place a greater strain and tension on the achilles tendon. Therefore it is important to take these factors into consideration when looking for everyday footwear.
Morton’s Neuroma – A Morton’s Neuroma is a pain in the forefoot, associated with inflammation of the nerves. Again, there are many contributing factors to development of a Morton’s Neuroma, but shoes with ill support and compression in the forefoot can place you at a higher risk of a neuroma. Make sure you look for shoes that provide enough space in the forefoot or the toebox.
Knee pain – As previously mentioned, flat shoes can promote excessive pronation of the feet. This pronatory force during gait can then begin to affect the body further up the chain. Pronation can mean that the knee joint is compromised as there is a greater load coming through the medial (inside) aspect of the joint, this can cause damage and pain over time. A shoe with an arch support or perhaps even an orthotic device promotes a reduction in pronation and thus takes this excessive load off the knee joint.
What are some important considerations when purchasing your footwear?
Now that we know flat shoes can cause various issues, what are some features to look for in our footwear? There are many features that should be considered when deciding which style and brand of shoe will suit you and your feet. These include;
Size – Make sure your shoes are professionally fitted. You need to take the length and width of the shoe into consideration. Shoes that are too narrow in the toe box can lead to corns, blisters, nerve inflammation and other forefoot pathologies. If your shoes are too large or too small they can actually (over long periods to time) lead to structural changes to the foot, for example bunions or clawed/hammer toes.
Foot type – Your podiatrist can assess your foot type and discuss how this may affect your shoe choice. You may be pronated (roll in) or supinated (roll out) or perhaps you are neutral (not rolling in nor out).
Arch support – Depending on your foot posture or foot type, you may require a shoe that has some arch support. Without arch support or contour, your plantar fascia (the muscle responsible for your arch) will be taking excessive load and therefore will be more prone to plantar fasciitis – A degenerative condition of the muscle.
Cushioning and shock absorption – Your footwear should provide a soft, cushioned surface for your foot. Your cushioned shoe will absorb shock, which means the overall impact on your joints is lower. Cushioned footwear also tends to be more comfortable than a hard, thin sole.
Ankle support – Flat shoes rarely provide ankle support. Consider ballet flats or thongs, neither of these styles have anything supporting or surrounding the ankles, this can mean your are more prone to ankle sprains.
Other things to consider:
What surface will you be wearing them on? Hard, soft or maybe uneven? Your shoe type should be determined by the type of surface you will be spending most of your time on. An example of this is that a shoe worn on a hard surface should have plenty of cushioning and shock absorption to support the joints and the soft tissue structures and protect them from sustaining injury.
How much time will you be spending in them? If you are spending all day every day in these shoes you need to make sure they provide you with all of the features discussed above. If you intend on only spending small amounts of time in your shoes you can get away with less of these ideal features.
What type of activity will you be doing in them? Are you going to be walking, running, jumping, standing still for long periods of time? Your shoe will need to accommodate for the type of movement you intend on doing, for example if you are doing side to side movements your shoe needs to provide medial and lateral (inside and outside of the foot) support.
How flexible are your shoes? In most cases, a flexible shoe is not a positive feature. Your foot is not generally overly flexible and therefore a shoe that is flexible will not provide enough support for the structures of the foot. A good shoe will be durable and only flexible where the foot is flexible.
Are your shoes made of breathable materials? While we need our footwear to be durable, we also need to consider how much air can get to our feet. Sweaty feet provide a perfect environment for fungal infections to the skin, Ie tinea pedis (or athlete’s foot).
How long have you had your current pair of shoes? You can tell how worn your shoes are by looking at the wear patterns on the sole, or the materials of the outer aspect of the shoe. As a general rule of thumb, you should replace your shoes every 6 – 12 months, or after about 700kms. It is also a good idea to swap between a few pairs of shoes, that way your shoes will tend to last a little bit longer.
Harnessing the natural protective mechanisms of feet
All this talk about shoes, but what about the barefoot concept? How could this help my feet? While we know shoes were originally designed to protect and support our feet, could this actually be making them more prone to injury?
The barefoot concept suggests that we should go back to our roots and allow the foot to work the way it does naturally. The research suggests that by engaging in more barefoot activity, we are able to encourage strengthening of the intrinsic muscles of the feet and conversely, by wearing shoes we are teaching the muscles of the feet to switch off, leaving us more prone to injury. The issue now being that transitioning from high levels of support, back to barefoot, will also place us at a great risk of injury. So what’s the solution here? We recommend a balance between both shoes with fantastic support and spending time barefoot (at home). (The one exception to this is if you suffer neuropathy of the feet; it is always recommended you are wearing footwear in this case). We also recommend talking to your podiatrist about ways to introduce intrinsic muscle strengthening of the feet – With great persistence, this can reduce your risk of injury and foot-related issues.
We can conclude that shoes with a strong heel counter, ankle support, arch support and a wider toe box are better for our feet and may reduce our risk of injury and foot related issues. We know that flat shoes can over time cause many different risk factors and can be detrimental to our biomechanics. We understand that choosing the correct footwear is proving to be a difficult task, so make sure you book with one of our Podiatrists today. Be sure to bring in your current footwear for assessment!