Healthy shoes, healthy feet!
Pain, tired feet? Many people have foot, ankle, and knee problems. Good shoes are essential for this. But what are good shoes: orthopedic shoes, sports shoes, slippers, with or without cushioning, with or without heels? In this blog, a new look at shoes and foot health from a therapeutic-anatomical perspective.
Why do we wear shoes? Fashion or function?
Young people have given shoes, especially sneakers, the status of a 'fashion statement' with sometimes showpieces of a limited edition of 2000 dollars! Older people, on the other hand, are more likely to wear simple (cheap) shoes with bulging, swollen, and discolored feet, while their foot and ankle joints require more care.
Healthy feet start with healthy shoes. We walk in shoes all day long. It has been shown that walking in shoes is more comfortable, better, and safer for your joints and causes fewer (foot) injuries than barefoot. Good shoes don't have to be expensive, but I see people walking in 5 dollars 'slippers' that are really deadly to the joints. That's the other extreme. Hence, my blog with physiotherapeutic-anatomically responsible shoe advice.
What are the best shoes?
When patients with foot, ankle, knee, and hip complaints consult me, I start with an analysis of the joints and shoe advice. It has been shown that most complaints of the knee, hip, and even pelvis have their origin in the feet and good shoes form the basis for good position and function of the feet. [1]
If you are not prepared to invest in good shoes with foot and leg complaints, therapy is of little use. It has been shown that Achilles tendon complaints, heel pain, tendon plate pain, knee pain, but also sports performance are influenced by footwear! I see people with 'bad shoes' who have been advised to use arch supports, while there is no scientific evidence for the use of arch supports for foot and knee pain! [2] Due to the arch support, the shoe pinches even more and has the opposite effect on the complaints. So yes, time for good shoes.
I start my blog the other way around: I immediately give away the clue, a checklist, and (in my view) the best shoe advice. Then I will substantiate my advice step by step.
Why shoes with cushioning?
Especially in the summer, many people walk in simple shoes without a foot bed and cushioning soles. Specifically, the ballerina shoes where you walk almost directly on the ground without any support or cushioning are fatal for the feet. Shoes with cushioning in the soles and in the foot bed are more comfortable and softer and are better for the joints. They act as shock absorbers so that the muscles and joints need to absorb less shock.
Much research has been done into the effect of walking barefoot and with minimalist (sports) shoes: the less cushioning in the soles, the less arch support, the more pain in the feet, the more swelling, foot complaints, injuries, and even more likely to break bones. [3] There are schools that claim that walking barefoot is better because it is more 'natural', you have more contact with the ground and therefore get more 'feedback' and can perform better. But there is no scientific evidence for that. [4] My advice is: don't go barefoot at home, but healthy flip-flops.
The other extreme is orthopedic shoes. Elderly people with foot pain are often prescribed expensive orthopedic shoes, while their effect has not been proven! It has been shown that people do not wear these shoes because they find them uncomfortable and ugly. [5]
They are often hard and stiff, blocking the joints and making the stiff joints even stiffer! It has been shown that ordinary modern sports shoes with soft cushioning soles and molded foot beds, such as certain flip-flops, [6] are more effective and significantly reduce pain in the feet in people with foot complaints. [5]
The more cushioning, the better. Sports shoes with cushioned soles, which also protect the feet and give a better gait, are preferable to ordinary flip-flops [7]. Especially the flatter flip-flops [6] demand more flexibility from the joints and slow down the gait pattern. Studies have shown that slowing the gait puts more stress on the tendons and increases the risk of injury.
A small disadvantage in winter is that as the temperature decreases, the shock absorption of sports shoes also decreases. [8]
Cushioned sneakers and flip-flops with a good foot bed are the best 'orthopedic shoes'
Why heel raise?
The answer is simple: we have stiff ankles due to our lifestyle, and that calls for a heel lift.
Our ankles have become too stiff from sitting too much. To stand up straight, your ankles need to be able to make a 90-degree angle. This is the 0 position. To walk, your feet must still be able to move 20 degrees toward your shin. We call this range of motion a 'dorsiflexion' of 20 degrees. Due to our sedentary lifestyle, most people have stiff ankles with reduced dorsiflexion of sometimes minus 20 degrees! Standing on flat-soled shoes forces your ankle to the 0-position and then causes more pain and twisting of the ankle and foot.
Anyone with stiff ankles walks more easily in heels. You then stand with your forefoot slightly down, so that you experience more freedom of movement and the ankle is no longer pushed into the final position. Shoes with heels require less ankle mobility and promote the activity of the foot and leg muscles. [9]
The older, the stiffer the dorsiflexion, making the elderly more likely to fall and therefore suffer permanent disability or even death. [10; 11] Improving foot flexibility with physiotherapy and good shoes reduces the risk of falls.
Heel elevation reduces the load on the Achilles tendon and therefore Achilles tendon complaints. This can also be done by means of a heel increase in the shoe. [12]
Tip: Place the heel lift under the insole so that it slides less!
Should everyone wear high heels now?
No, that's not what I mean. Frequent walking in high heels (10 cm) makes the feet stiffer and the arch flatter, reducing the springiness in the feet. [13] Middle-aged women who often wear high heels develop a stiffer back and pelvis, while this phenomenon does not occur in young women. I recommend low heels (2-4 cm). This gives the ankle more space and does not have the adverse effects of high heels (10 cm).[14]
Anti Pronation sole? Rather not!
Many elderly people have sagging feet and are advised to use anti pronation orthotics to prevent sagging. There are also sports shoes with built-in anti pronation soles, but that is not convenient. As indicated earlier, there is no scientific evidence that the use of arch supports for foot and knee pain would work better than a 'regular' sole. [2]
Lack of dorsiflexion is the biggest cause of foot sagging (overprotection). [15] If the ankle bone cannot rise, it will tilt sideways. The body is looking for another way to still be able to move. Please note: the sagging of the foot is not a deviation (!), but a functional adjustment. That is why we do not recommend anti-pronation insoles because they block ankle movement. The ankle can then not move and there is even more twisting in the knees. A heel is better advice.
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Advice for sagging feet: No 'arch supports', but a heel increase that compensates for the blockage and at the same time good physiotherapy to tackle the ankle blockage.
Sufficient space in the shoe? Cinderella Syndrome.
Just look in a restaurant, under the table, how many women have taken off their shoes. It seems like a kind of Cinderella syndrome when you see how many women walk in princess slippers that are way too small. Many shoes, especially women's shoes, are much too small and narrow. Shoes that are too narrow block the circulation and fluid flow (congestion), impede muscle function, block the joints and eventually deform the feet. This can certainly have fatal consequences for people with foot problems, such as the elderly and people with diabetes. By simply buying shoes with enough room to move so that you can easily get in and out and move your toes, many complaints can be prevented and reduced, especially in the elderly. [16]
Step 1: Draw the outline of your foot on the paper.
Step 2: Place your shoe on top and draw the outline.
Step 3: assess: does your foot fit comfortably in the shoe?
Depending on the material and use, shoes will last one or two years. The shape of your feet also changes. The advice for runners is to change shoes after a maximum of 500-700 km. Research showed that after 350 km, the quality of all sports shoes has decreased and has less suspension and cushioning, regardless of the type of cushioning. [17] So the average recreational runner needs new shoes every year. Maybe it's time to clear out your shoe closet?
Between 71 – 87% of the elderly have foot complaints. Foot complaints increase with age. [18] Attention to good shoes can clearly reduce these complaints and many joint complaints, and improve the quality of life of the elderly. [19] That is why it is strange that so little attention is paid to it. Paying attention to healthy feet and good shoes can improve the freedom of movement and independence of the elderly. [20] I also prefer to see the elderly walking in nice flexible, springy sports shoes. The more comfortable you walk, the more inclined you are to take some extra walks. Promoting an active lifestyle and preferably daily walking is of vital importance, especially for the elderly. [21] Good shoes are therefore a useful and necessary investment.
Tazzrot shoes are definitely recommended for people with very stiff feet and ankles. These shoes have a kind of unwind bar built-in as a round bottom hem. Tazzrot stands for Choose your own shoes. Walking in these shoes puts less pressure on the foot and ankle joints and the gait cycle is easier. [23] You roll over the round sole and less in your joints.
And last but not least
Have you had any other advice from your healthcare provider? Don't panic, my intention is not to undermine that, but to broaden the view on shoes and foot complaints. If the advice you have received has sufficient results, then just keep going. If not, maybe try another way. Not every piece of advice works for everyone, so… just try it out.
Make sure you have shoes that walk well, they really don't have to be expensive.
Do you have corrective insoles and are you unsure whether you should get rid of them? Try without it for a week and see for yourself if it works better. If you suffer more, then you know that the insoles do work for you.
Spending eight hours a day on an office chair may be unhealthy, but according to research, a standing occupation is no guarantee for better health. In addition, wear the wrong footwear, and you can get countless physical complaints in the long run. We explain below what you should wear.
For people with jobs that require you to stand up all day - such as shop assistants, waiters, nurses, etc. - it is necessary to invest in decent shoes because otherwise, you can get chronic back and foot problems and eventually even fused feet and toes.
The most important rule is that you buy shoes that support the sole of the foot. So no ballerinas or other extremely flat footwear, but sneakers with a somewhat thicker sole, for example. Still good – however contradictory that may sound – is a shoe with a small (!) heel. Maximum 4 cm, preferably around 2 cm. Such heels ensure that your pelvis remains nicely straight, which prevents back problems.
Do you have (expensive) orthopedic shoes and are you still not happy? Try some Tazzrot shoes with cushioned soles. If that feels better, then that's a better choice for you, right? Then you know that the Tazzrot shoes will work for you.
Let stiff ankles be mobilized by good Sneaker shoes. That really pays off. We certainly achieve good results with the new Tazzrot shoes?. Do you enjoy living more!
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