If the Shoe Fits
If the shoe fits....
Footwear has to serve many functions – protection, support and style. Most of us manage to find shoes that are comfortable, socially acceptable, and aesthetically pleasing. This does however become a problem when our feet don’t conform to the standards of the mass produced footwear. Human feet come in all shapes and sizes – shoes however come in all sizes but very few shapes. If you have a wide forefoot, as in bunions, the shoe that fits the front of your foot leaves your heel floating, and the right sized shoe ends up squeezing the bunion – so when you cannot get a shoe to fit the foot, surgery makes the foot fit the shoe.
However some common conditions can be accommodated by careful choice of footwear and customization with appropriate inserts. Arthritis of the big toe joint can be made more comfortable in a shoe with a rigid inner sole which prevents the toe from bending, and an outer sole with a gentle curve at the front (i.e. a forefoot rocker) which allows the foot to rock forward while walking without needing to bend the toe. People with ankle or hindfoot arthritis may find they can walk further with boots that lace up firmly above their ankles.
Occasionally custom-made orthotics and shoe inserts can do the trick. Pain across the ball of the foot can be relieved with an insert with an appropriately placed pad to lift up the offending metatarsal heads and relieve the pressure on walking. Flat foot in adults in the early stages requires a customised arch support worn in a supportive shoe to improve the mechanics of the foot and relieve the pain.
Finding the right shoe can be difficult and may require a compromise between practicality and fashion. The shoe has to open up wide enough to allow the foot to go in, be deep enough to accommodate the foot as well as any insert, and supportive enough to keep the foot aligned over the sole. The best time to shop for footwear is when the foot is at its broadest – towards the end of the working day.
Complex problems require complex orthotics which can often be bulky necessitating bespoke shoes or boots. This can often be a challenge and surgery may be required to make the foot “shoe-able”.
When inserts and shoe modifications are not enough, surgery may have a role, but if the shoe fits...
Mr. Melwyn Pereira MBBS, MS, D.Orth, FRCS (Tr&Orth) holds specialist Foot and Ankle Clinics at The Joint Clinic on Monday afternoons. For further information please contact 01905 799116.
