Shoes play a significant role in supporting not just the feet, but the entire body. The importance of shoes cannot be understated. Wise choice in footwear not only influences posture, but also knee, back and feet. There are 3 basic categories of athletic shoes: stability, neutral and motion control. 

Stability shoes are the most popular. It has a combination of cushioning and support in addition to a strong heel counter preventing excessive pronation. Pronation is controlled by posting firm reinforcing materials on the medial (inside border) side of shoes. Most athletic shoe brands carry a spectrum of stability shoes from more to less aggressive support.  

Since a foot that consistently over pronates can cause a host of issues including knee, foot, ankle, hip and back pain - having good supportive shoes is essential. Shoes can bring the foot back into a neutral position creating better posture and function throughout all joints of the body. 

For those needing a stiffer shoe with more control, look to the motion control shoe.

Motion control shoes are heavier and stiffer shoes. It controls pronation to a higher degree than stability shoes. It is straight lasted (sole is straighter versus curved inward) with a wider heel counter/heel base. It has more cushioning in addition to more support. Some people find it has too much support and is too big and bulky. But others find that it is the only type of shoe they can wear. My student who has plantar fasciitis finds motion control shoe is the only kind she can wear. For maximum cushioning and control look to a motion control shoe.

Neutral shoes can be used with either generic or custom orthotics. However, they are the ideal choice for custom orthotics as they are neutral shoe without added support, allowing the custom orthotic to work as intended without external influences. The shoe as a whole is more cushiony and soft than the stability or motion control shoe. 

Theoretically neutral shoes should be neutral. But in reality, sometimes they are not completely neutral. I have felt neutral shoes that have some medial support or strong heel counters like a stability shoes. All neutral shoes are not created equally, same for stability and motion control shoes. It is always best to try on a variety of shoes to find the one that that will be most comfortable for you. 

Factors to consider when choosing shoes

1. If you have bunions that hit you in the wrong place, or sensitive areas in your foot, it’s best to look for shoes that are made of softer materials.
2. Some shoe brands run narrow, and others run wide. For example, Brooks and Saucony are known for running wider in width, but ASICS has a reputation for running more narrow. Some brands have a large variety of widths like New Balance, others are more limited. 
3. Buying a larger size is recommended when purchasing running shoes. I typically wear 8 wide in street shoes but need to buy 9 wide in running shoes. You usually have to go up one full size or sometimes a size and a half in athletic running shoes compared to street shoes. You never want running shoes to fit too snugly. There needs to be some room at the toe area.
4. Cushier versus firmer heel. I don’t like cushy heels, they hurt my back but some people love them.
5. Heel height to toe ratio varies, so try a variety of shoes to see what is most comfortable for you.  I personally prefer a higher heel to toe ratio. I feel more more supported and it is more comfortable for my back. Running shoes generally have a higher heel to toe ratio than a walking shoe. This is because running shoes are ergonomically designed for just that, running. The height in the heel helps the propel the body forward. 
6. Athletic shoes, particularly running shoes are extremely comfortable and supportive, but they do wear out more quickly than street shoes. The foam starts to break down with wear, even in more costly shoes. I change my shoes every 3 months; I can start to feel how they go flat reducing shock absorption to my whole body.  Keep in mind, how soon the shoe wears out will be dependent upon usage.
7. If in a stability or motion control shoe, the foam on the outside wears down at a higher rate than the medial or inside border of the shoes. This starts to drop the shoe laterally and can effect the mechanics of the whole body. In a neutral shoe the foam wears out more evenly since it does not have medial posting making the inside border of the shoe firmer that the outside border. But it may wear out on one side more than another depending upon each person’s gait pattern and will lose its shock absorption over time as will any athletic shoe. 
8. Specialty shoe stores often have a policy of allowing the customer to exchange shoes bought in their store within or 2-4 weeks of purchase. I recommend buying from these stores because you will be able to exchange  shoes. Sometimes the few minutes of trying on the shoe in the store will not be enough time to know if it is the right shoe for you.  
9. You never want too much support in an orthotic. This tendency usually happens in custom orthotics more than generic and changes the mechanics of the kinetic chain.  For example, an arch that is too high will inhibit pronation. Pronation allows shock absorption for the body. Without adequate shock absorption the back may become sore. It can also cause knee pain due to the external rotation of the tibia out of neutral position, this in turn can cause poor postural alignment. Find footwear that in neutral position, without over correction.

Tripod foot and Neutral position

The tripod foot consists of the first metatarsal, fifth metatarsal joints and heel.  In other words, the ball of the big toe, ball of little toe and heel. These three points should make contact with the ground when standing. Stabilizing and grounding the foot in this way sets up a good foundation for the entire body, enabling it to produce maximum power and force. It also encourages muscle activation enabling the whole body to become strong and stable. Planting the 3 points of the foot puts it into neutral position. This ideal neutral alignment moves up the kinetic chain encouraging good mechanics throughout the body. The proper shoe/orthotic helps the foot find the tripod foot.

Orthotics

Orthotics can play a crucial role in everyday foot comfort and athletic performance. Getting the right amount of support reduces stress on the foot as well as the entire body. Orthotics helps to align the body from the feet up. They can help not only the feet, but the entire body.

Orthotics can be custom made by podiatrists, physical therapists, orthotists, chiropractors and generic ones can be bought in drug stores, shoe stores, medical supply businesses as well as online sites.

There are two basic categories of orthotics; custom made and generic  orthotics. 

Custom Orthotics

Custom orthotics are casted to each person’s individual foot. They can be full length or 3/4 length, hard or soft, or a combination of harder and softer materials.  They are also considerably more expensive than store bought orthotics. Many who wear custom orthotics find great relief not only to the feet, but to the entire body. Others do not find their custom orthotics comfortable, particularly when they are made of harder, less flexible materials. If you do not have success with custom orthotics, good quality generic orthotics are an excellent alternative. 

Generic orthotics 

Most of my students prefer generic orthotics, not only because they are more reasonably priced than custom, but also because they find them more comfortable. The key is to find the right one for you. Orthotics can have varying degrees of arch support, metatarsal support, a higher or lower heel to toe ratio, and can be either 3/4 or full length. Since there are so many variations  it is important to take the time to find the right one for you. Through trial and error I have found a group of brands that are consistently effective and comfortable. They are Superfeet, Spenco, Pedag and Tacco. I generally suggest Superfeet and Spenco for athletic shoes and Pedag or Tacco for casual shoes. I have consistently gotten great feedback from my students over the years on these solid brands. That doesn’t mean there aren’t other brands that may work well for you and your particular needs. Take the time to find the right one for you.

Custom vs Generic orthotics

Many times I get the question should I buy custom orthotics? Should I spend the money? Do you think they will work? 

Custom orthotics are considerably more expensive than store bought and there is no guarantee that a custom orthotic will resolve an issue. But since custom orthotics are considerably more expensive it is logical to try store bought orthotics first. The general rule is you do not want to over correct by putting in more orthotic than you need. It is best to get the minimum amount of support allowing the foot and body muscles to work.

If you feel you need more customized support, then custom orthotics are an option. There is great value in custom orthotics and  I have owned many throughout the years.  When I am loading my body more dynamically with force I may reach for my custom orthotics to support the greater impact to my feet and body. But on a regular basis when I am not loading my body excessively, I am more comfortable in a good stability shoe with a store bought orthotic.

Can stability/motion control shoes replace orthotics?

Yes and no. It cannot exactly replicate a custom orthotic that is specially casted to your foot. But it can give a great amount of stability which may be sufficient. Motion control/stability shoes have a strong heel counter stabilizing the foot upon the initial heel strike and strong medial posting preventing over pronation. These factors enable the shoe to function as a mild orthotic, which is often sufficient support.

What kind of shoe works best with a custom orthotic?

A neutral shoe works best with a custom orthotic as it allows the orthotic  to function without external influence. Custom orthotics are created under the assumption it will function on a flat surface, not a surface in which the inside border of the shoe (arch area) is firmer than the lateral (outside) side of the shoe like a motion control or stability shoe. It is important to note that some shoes advertise itself as neutral but are not completely neutral. It may have some medial support built into the shoe. To find the right shoe, make sure to try a variety of shoes with your orthotics.

What shoes are best for generic orthotics?

Generic full length orthotics made for sports should be used with a shoe that has a removable insole. Generic full length insoles that have a thin profile and are not made for sports but casual wear, can be placed directly inside the shoe. 

Some generic orthotics have higher arches and need to be worn with a more neutral shoe. Other orthotics that are less aggressive can be combined with a stability shoe.

Be cautious when combining a high arch orthotic with a stability/motion control shoe. It can put the foot in a supinated position causing the foot to roll outwards. Excessive supination creates a lateral torque on the knee and can cause pain. 

Every situation is different and dependent upon the support of the shoe, the orthotic and the individuality of each person’s foot. Try different combinations to get the right arrangement of shoe and orthotic for you. If you have bought a stability or motion control shoe you may not need additional support as the shoe itself may have sufficient support. However, others may need to add a bit more support. The only way to find out the best shoe/orthotic arrangement for you is to experiment and find out what combination of shoe/orthotic works best for you. 

Alanna’ Story

My older adult student named Alanna, suffered from plantar fasciitis and arthritis in her feet. She had been to 4 podiatrists, had numerous injections and nothing worked. The podiatrist  told her custom orthotics would not work either due to her foot sensitivity. The doctor told her she needed to go shoe shopping. 

By looking at her X-rays with doctor and seeing her arthritis I knew she needed a stiff shoe, one that would control the amount of movement her feet made through the gait cycle. I took her to a specialty running store and picked out a motion control shoe for her. That shoe enabled her to walk without pain. I also added a Spenco cross training insole to give a bit more arch support and cushioning. Motion control shoes are generally big and Alanna had a thin, narrow foot. The orthotic not only gave her cushioning but filled up space making the more secure, preventing her feet from moving too much inside the shoe. 

It would be ideal if a shoe could fit our feet like a glove, but since that is not always the case adjustments can be made with orthotics and technical socks. Technical socks give extra support to the heels and forefoot, they can also have more compression supporting the arch. They come in thicker and thinner models. I suggested she buy a thicker technical sock to cushion and secure her foot in the shoe even further. 

In conclusion, Alana got the right motion control shoe, an additional supportive but completely pliable generic orthotic and technical socks. With these three items she could walk without pain. 

The combination of a strong motion control shoe with additional support finally enabled her to be on her feet for many hours without pain.  However, I did warn her that although the shoes were on the pricier side, they would wear out and that she needed to change them regularly. The thing that made her athletic shoes so comfortable, the cushier foam, is exactly what would wear out and start to tip her foot into supination taking her foot out of neutral position. This happens because on a motion control or stability shoe the medial or inside part of the shoe is always firmer and does not flatten out but generally stays stiff as opposed to the softer foam on the lateral side. I estimated the shoe would start to lose its integrity in about 3 months if she wore them all the time. 

After awhile Alana started having foot pain again, she got injections to try and ease the pain but to no avail. She also asked the podiatrist to put her in a cast which made things worse. Due to painful feet she had to stop taking pilates classes. I visited her at home to try to see if I could help her. I looked on the bottom of her shoes and noticed the tread was gone, I asked how long she had them. She said it had been over a year. I told her that was not good. She ordered new ones right away and felt better right away, but said it didn’t take away all her pain. I told her it would take time because she had been in a poor mechanical position for so long and her feet had slowly learned to function in a dysfunctional manner. I estimated it would take 6 months to start feeling better.  It did take 6 months. 

Now she keeps an extra pair on hand. I told her if she thinks her shoes are wearing out try the new pair and compare it to her current pair, she will know immediately if the shoe is starting to wear out. Now she changes her shoes every 2 1/2 to 3 months. She told me she could never go through that pain again. She felt disabled and the doctors could not provide her a solution. She realized in order to be independent she needed to be able to walk without pain. A great quality supportive shoe, replaced every 3 months, enabled her to be mobile and independent and most importantly, pain free.

 Power of Footwear

Feet are the foundation of the entire body. Good mechanics and alignment start at the feet. Misalignment at the feet sets up the body for misalignment throughout the body. Appropriate footwear/orthotics assists in putting the foot into neutral position bringing the entire body into alignment. This correct setup travels up the kinetic chain throughout the skeleton affecting the knees, hip, back and neck. From this correct foundation the body can produce its maximum power as well as reduce risk of injuries.

The right footwear sets up a correct foundation for the entire body, allowing the body to function optimally.