Footwear in Orthopaedics

Orthoses

Orthotics are shoes, shoe inserts or leg braces that alter the way the leg, foot or ankle sit and move. These are most often foot orthotics or shoe inserts. Other orthotics include supports for the ankle, knee, hip or combinations of these.

Uses for orthotics include:

  • Relieving symptoms – like pain, e.g. metatarsalgia may be treated with a foot orthotic that transfers weight to other areas of the foot during walking
  • Support – e.g. orthotics to support high arches.
  • Maintaining alignment
  • Prevent injuries & deformities developing:
  • e.g. prevents shortening of the Achilles

Types of orthotics:

  1. Accommodative
  2. Semi-Rigid
  3. Rigid
  4. Semi-Prosthesis

Your orthotic should be:

  • Comfortable
  • improve rather than impede walking – they should facilitate painless rolling of the foot during ambulation.

Footwear in Orthopaedics

Shoes for Everyday

Wearing shoes that protect the normal shape and function of your foot is vital to preventing injury and pain.

‘Healthy’ shoes are those that promote the smooth transfer of your weight through your heel to toe while providing adequate support of your arches and joints.

There are a number of ways to ensure your shoes are ‘healthy’:

  • Buy shoes that fit your feet well, rather than expecting shoes to stretch around your feet. Remember that while leather will stretch gradually, synthetic shoes will stretch very little.
  • Try on shoes at the end of the day after walking around. Our feet tend to swell towards the end of the day, making them bigger.
  • Rotate your shoes. Wearing the same pair of shoes day after day can alter your foot shape and function.
  • Reduce the risk of shoes rubbing on edges of the foot by buying shoes with a wide toe box.
  • Lace-up shoes and boots

Try to avoid wearing high-heeled shoes, especially if you have lower back pain or arthritis in any of the joints in your legs.

Who uses specialised shoes?

There are a variety of reasons that a podiatrist or orthotist will recommend specialised footwear, including protecting the feet from further injury, controlling symptoms like pain or supporting deformed feet.

Some conditions that use specialised shoes as part of their treatment include:

Modified Footwear

Modifications can be designed to fit a deformed foot, to stabilise feet or improve ambulation.

Modifications include flares, which provide stability;
extended shanks to reduce bending stresses; rocker soles to rock
the foot from heel strike to toe-off; and relasting, or reshaping,
shoes to accommodate deformities.

Footwear in Sports

Sports shoes are designed around the demands of a particular activity, and the differences are real rather than marketing. Running shoes are built for repeated forward loading and cushioning. Court shoes for tennis, netball and basketball are built for sideways movement and have more support around the midfoot and a flatter, grippier sole. Football and other field boots use studs for grip on grass, which increases traction but also the twisting forces on the knee and ankle.

Choosing running shoes

  • Comfort is the best guide. There is no good evidence that matching a shoe to your arch height prevents injury, despite how often shoes are sold on that basis. The shoe that feels best when you run in it is usually the right one.
  • Fit them late in the day when your feet are largest, wearing the socks you run in, and allow about a thumb’s width beyond the longest toe.
  • Width matters as much as length. Most repeat forefoot problems come from a toe box that is too narrow.
  • Replace them when the midsole feels flat and unresponsive, rather than when the upper looks worn. Runners commonly get several hundred kilometres from a pair, but this varies widely with weight, surface and running style.

Changing shoe type

Switching to a very different shoe — particularly a minimalist or lower-heeled one — changes where load goes through the foot and lower leg. Make the change over weeks rather than at once. Sudden changes in footwear are a recognised cause of stress fracture and Achilles problems.

Studs and grip

Longer studs and higher-grip surfaces hold the foot more firmly, which helps performance but transmits more force to the knee and ankle when you turn. Match the stud type to the ground conditions rather than using the same boots year-round.

See also preventing injury for athletes.

F.A.Q.s | Frequently Asked Questions

Do I need expensive running shoes?

No. Price is a poor predictor of whether a shoe suits you. Comfort and fit matter considerably more, and the most expensive shoe in the shop is not more likely to prevent injury than a mid-range one that fits you properly.

Do orthotics have to be custom-made?

Not always. Off-the-shelf insoles work well for many people and cost far less. Custom orthotics are worth it where the foot shape is unusual, where there is a specific deformity to accommodate, or where off-the-shelf devices have already been tried without success — for instance in the diabetic foot, where protecting the skin is the priority.

How do I know when to replace my shoes?

Judge by the midsole rather than the upper. If it feels flat, or the shoe has lost its spring, it has done its job even if it looks fine. Aches that appear in old shoes and disappear in new ones are a reliable sign.

Are barefoot or minimalist shoes better?

They are not clearly better or worse — they load the foot and calf differently rather than more naturally. The risk is in the transition: moving into them suddenly is a well-recognised cause of stress fractures and Achilles pain. If you want to try them, change over gradually.

What shoes help if I have arthritis in my foot?

Generally a stiff or rocker sole, a wide and deep toe box, cushioning, and a low heel. The stiffness is the important part, because it reduces how much the painful joints have to bend as you walk. See arthritis of the big toe and ankle arthritis.

What should I look for in children’s shoes?

A flexible sole, a wide toe box, and enough length that the foot is not cramped — children’s feet grow in bursts, so check the fit regularly. Healthy children do not need arch support built into everyday shoes.