Updated May 31, 2007

How to Choose Footwear

by Roy H. Lidtke, D.P.M., C.Ped.

It is a good idea to look for a shoe store with certified shoe fitters or certified pedorthists on staff. (You can get a list of certified pedorthists in your area by visitng Web site of The American Board for Certification in Orthotics, Prosthetics, & Pedorthics at www.abcop.org.) A knowledgeable staff person will know the subtle differences in the sizes and shapes among brands and even among models within a brand. This kind of information and the help of a professional can be especially useful if you have any loss of sensation in your feet that prevents you from being able to tell whether a shoe is rubbing. A store with certified staff on board will generally also be happy to special order shoes for you if they do not have your size.

Lacing options
Although shoes should fit comfortably off the shelf, with no need for breaking in, you can fine-tune the fit by adjusting or changing the laces and lacing patterns.

Generally, round laces tend to stretch more than flat laces, making them a good choice for walking shoes. As you walk, your foot changes shape. Shoes and laces with some give, or flexibility, can accommodate those changes, while rigid shoes and inflexible laces will create pressure against your skin. The amount of give in a shoe is also influenced by the type of eyelets the laces go through. As a general rule, fabric or leather loops give more than plastic or metal eyelets, and eyelets give more than punched-out holes. However, hard plastic or metal eyelets can irritate the top of the foot, so choose shoes with loops or punched-out holes whenever possible.

Lacing patterns can be altered to accommodate a variety of foot shapes. For example, there is a tendency for the front of the foot to widen as a result of neuropathy, a flattening arch, or simply increasing age. If the front of the foot is wide and the heel is narrow, or if the foot swells significantly during the day, two sets of laces can be used so the bottom tie can be loosened, allowing for more room in the front of the shoe. (For more information and diagrams, click on “Lacing Patterns.”).

A person who has a high arch or a bump on the top of his foot can skip the crisscross lacing pattern in the area near the arch or bump and instead string the laces straight up to the next eyelet. Another way to deal with a high arch is to weave the laces straight across the tongue of the shoe, rather than diagonally. If more room is needed in the toe area, try stringing one end of the lace from the bottom eyelet to the top eyelet on the opposite side, then pulling the lace to lift the front of the shoe and increase room in the toe box. If the heel of the foot is narrow or is slipping inside the shoe excessively, the laces can be looped through one another at the top before being tied.

How do they look?
The key to finding a comfortable, attractive shoe is to find a store with a wide selection. Stores that have footwear from around the world are a good place to start; there are many well-designed shoes from Europe and New Zealand. Take your time selecting a pair, and ask about the return policy just in case the style you select turns out not to be the right one for you. And remember this process—you will need to repeat it whenever you get a new pair of shoes, which should be every 6 to 12 months.

Also in this article:
Medicare Therapeutic Shoe Program

Dr. Lidtke is a professor and director of the Gait Analysis Lab at Rosalind Franklin University of Medicine and Science. He also serves on the faculty of Rush University Medical Center and the Weil Foot and Ankle Institute, both in Chicago, Illinois.

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