Aesthetics may supersede health considerations when it comes to buying shoes. Stephanie Fsadni thinks it might be a good idea to ditch her high-heeled sandals and opt for more supportive footwear to avoid long-term damage.

As we store away our heavy boots and unbox our sandals and flip-flops, we might sigh in relief at their light weight. But our feet may not rejoice as much.

Summer shoes tend to provide less support than their winter counterparts and are thus more conducive to foot problems.

“No footwear that does not firmly hold the ankle to the sole of the shoe can provide adequate support,” says podiatrist Christian Ellul.

“This can be achieved by having either an enclosed shoe with laces or Velcro straps or sandals with straps that fasten around the ankle.”

A popular type of shoe among men and women in summer has none of the above properties.

“Flip-flops provide no support whatsoever, offering only some basic protection to the bottom of the foot to walk around outdoors,” points out Ellul.

“They also cause our walking pattern to change and, without support, the foot is more prone to stresses. This can lead to falls, while foot ligament and tendon injuries are also much more common when wearing flip-flops.”

For the healthy adult without any foot problems – such as flat feet and bunions – he says that wearing flip-flops for a short period of time (e.g. going to the beach or using a gym shower) is “generally okay”.

“The sole of the flip-flop can be adequate to avoid contact with fungal spores or human papilloma virus (HPV) which cause athlete’s foot and foot warts. Having said that, walking barefoot outdoors particularly when using public pools or showers should be avoided in order to prevent foot infections which tend to be more common in summer.”

As regards women, they often tend to look at the aesthetics of a shoe rather than its overall qualities. They should, however, be cautious about high heels as heels higher than 5cm may have a significant effect on all the body, not just the feet.

No footwear that does not firmly hold the ankle to the sole of the shoe can provide adequate support

“Immediately upon putting on high heels, the chest moves forward, as does the lower back, resulting in the hips and spine going out of alignment,” explains Ellul.

“Excess pressure is also created on the knees and an abnormal weight is put on the ball of the foot since body weight is not distributed evenly across the sole.”

He says that problems usually arise as a consequence of prolonged daily wearing of high heels over a number of years. These can include tendonitis, with Achilles tendonitis (pain on the backside of the ankle) being particularly common, while spondylolisthesis (slippage of one vertebra forward over another) is also much more common in people wearing high heels for a long time.

With respect to the foot, placing excessive loading of weight on the ball of the foot can give rise to metatarsal and nerve pain that can lead to a tingling ‘pins and needles’ sensation across the toes.

“If one must wear high heels, the best thing is to avoid wearing them over long periods of time, try and set the heel limit to 5cm while wedges should be preferred over stilettos.

“Furthermore, one should go for rounded instead of pointed shoes,” recommends Ellul.

One may think of ballerina shoes as good alternatives as they are flat but it’s not the case.

“Ballerina shoes are the antithesis of good supportive footwear as they have no ankle/arch support or straps which can hold the foot to shoe. Furthermore, the material of ballerina shoes is generally too soft.

“Given these are slip-ons, as the material expands with use, feet become prone to constant rubbing and friction making the foot prone to stresses, abrasions, calluses, corns and blisters.

“People prone to excessive pronation (flat foot/inward rolling of the foot during walking) should avoid this type of shoe.”

One should also buy shoes that fit properly.

“Ill-fitting shoes such as those too tight or too narrow, such as pointed footwear, can cause a neuroma formation in the ball of the foot. Left untreated, this may become a chronic problem with frequent nerve pain including tingling and a pins and needles sensation in the ball of the foot and toes.

“This worsens when wearing narrow footwear shapes and is alleviated when wearing shoes with a wide toe-box.

“On the other hand, loose shoes increase the risk of tripping, abrasions or blister formation due to constant rubbing between the skin and the shoe.”

Another common problem associated with wearing the wrong footwear is heel pain, commonly caused by plantar fasciitis (an inflammation of a muscle that originates from the heel).

All these issues could be avoided if one chooses the right shoes. Also, many problems related to the foot as a consequence of bad footwear are reversible, if action is taken immediately, according to Ellul.

“It should be recognised that it is not normal to have foot pain when wearing shoes. Many people often end up living and accepting the burden of pain as long as they are wearing fashionable shoes. It is at this stage that problems become more severe and less reversible.

“Our body responds with pain for any object that does us harm. We should therefore respond immediately to pain to avoid longterm consequences which in this case only requires us not to wear shoes that cause us such pain, no matter how fashionable and trendy it is.”

Orthopaedic shoes (a loose term meaning shoes providing more support to the foot than the conventional type) favour function over fashion, however, Ellul says that one may not really understand the term.

“In my practice, I encounter many people who refer to their fashionable footwear as ‘orthopaedic’ despite the fact that it contains no features of support, such as ankle or foot arch support,” he says, while adding that one should also be attentive of marketing ploys.

“Outlets, even branded ones, may market a particular type of footwear as orthopaedic despite not having crucial orthopaedic properties that provide support and function.”

He gives some suggestions as to what one should do and look out for when buying a pair of shoes.

“As a general rule, one should ideally purchase footwear in the afternoon as the foot is smallest in the morning, slightly increasing in size by the evening. In winter one should opt for boots and enclosed shoes, and in summer, one should go for sandals that fasten with straps around the ankle. All shoes should be able to hold the foot firmly while closed shoes should shape around the contours of the foot. The sole should be thick, providing enough cushioning for shock absorption, while the material around the ankle should be firm to provide support. The toes should be able to move easily.

“Women should restrict high heels over 5cm or pointed footwear to occasions, while people with flat feet should opt for shoes providing arch support.

“Nowadays, there are comfortable but fashionable alternatives out there, so no excuses!”

Christian Ellul is the policy leader of the Malta Association of Podiatrists and is currently reading for a PhD at the University of Malta.

ellulchristian@gmail.com

About walking barefoot

Opinions on walking barefoot are divided, with supporters claiming that going barefoot is better for your feet and reduces the risk of injuries caused by shoes, while experts are concerned about the lack of support and the damage that can occur as a result.

Christian Ellul believes that, first and foremost, one should consider the context.

“It should be noted that our foot was designed to function perfectly well without footwear. However, this does not apply to walking on concrete, tiles, tarmac and other rigid flat surfaces. These are all artificial terrains not created by nature and, as a result, we require shoes to give us adequate shock absorption during walking.”

However, he says that barefoot walking has its positives since it works our foot muscles thereby strengthening them.

“Barefoot walking is ideal on soft terrains such as sand, soil and rubber tracks. However, if one attempts barefoot exercise, this should be done with caution and only increased gradually as both the foot and the skin have to become adapted to the environment.

“Furthermore, this should be avoided in high-risk individuals such as those with diabetes and rheumatoid arthritis.”