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Pretty-Yet-Practical Footwear

Bottom Line/HEALTH: Many women like me are kidding ourselves, thinking that it’s worth the price we pay in foot pain to wear all those pretty, sexy shoes, because we’re kind of figuring that looks are far more important. Are we really kidding ourselves?
Dr. Johanna Youner: Long-term wearing of footwear that will deform your foot will create arthritis and permanent pain.
Bottom Line: Yeah, but the shoes look so pretty. Is there a way to wear them for a little while and then balance it out?
Dr. Youner: You can wear them—say you’re seated at dinner or at a party. If you’re not going to wear them for more than two hours or stay seated, you can wear them without hurting yourself. That means a high heel or a pointed shoe. Make sure the shoe fits.
Bottom Line: What does “shoe fits” mean?
Dr. Youner: Make sure it’s the right size for your foot. Many people have the wrong size in their head and buy the wrong size shoe. So make sure your foot gets sized at the shoe store. Purchase the right size. Purchase your shoe at the end of the day, when your foot’s at its biggest. Then you can wear your silly shoes to dinner.
Bottom Line: I’ve heard actually that women tend to buy shoes that are smaller than they should because they think it looks prettier to have a smaller foot.
Dr. Youner: So do men. Men are the same way, and it’s silly—vanity sizing is a big business, especially in shoes, and over the past 20 years, the average American shoe size has gone from a seven to an eight. So people are getting bigger. The joke is up—you can’t buy smaller shoes and get away with it. Buy the shoes that fit you.
Bottom Line: You talked about the fact that people’s feet have gotten bigger. Has there been shoe-size inflation as well, the same way that clothing is not sized the same as it used to be?
Dr. Youner: There’s no standardized sizing, but shoes have absolutely gotten bigger as people have gotten bigger. The average shoe in America has gone up one size…in England, two sizes. So what was the largest size in the store, a nine 20 years ago, the largest size is now 11. So we have access to larger shoes now.
Bottom Line: But people should not necessarily be doing do-it-yourself shoe fitting…or perhaps they should buy, if they buy online, multiple pairs of shoes at the same time?
Dr. Youner: Online shopping has opened up an entire world. If you can get your foot sized, it’s a good idea to get your foot sized. You go with the longest toe…you size for the left foot if you don’t have much time. Your podiatrist should have a Brannock device. This is a device that sizes your shoes.And a lot of shoe stores can size you, but of course, these days you’re going to get a box of shoes in the mail. So the best is to try a variety of sizes. Do not expect the shoes to break in. You’ll be breaking your feet, not your shoes.
Bottom Line: If somebody doesn’t have a regular podiatrist, can I go to the podiatrist and get just my shoe sized and not have to pay a big insurance payment for a visit?
Dr. Youner: Sure you can, if you just give a call and ask them if they have a moment. Because usually the staff is well-trained to do that.
Bottom Line: Let’s play what I’m fondly going to call “Doc in My Closet.” I’m opening my closet and admitting my shoe frailties. But let’s go through, because I think it’s important. Let’s talk about the dangers of what people are wearing, and then we’ll talk about some of the Dr. Youner–approved shoes. Deal?
Dr. Youner: Deal.
Bottom Line: So I did bring a selection of shoes. First one—true confession—this is actually my teenage daughter’s shoe, not mine. But every time she wears this, it scares the crap out of me. Presumably nothing to really talk about. Absolutely, don’t even wear it?
Dr. Youner: If you’re sitting down at a party or you can stand for less than two hours, maybe you can wear it. But you’re running the risk of getting metatarsalgia, inflammation of your metatarsals. You can fall and break your ankle in those. They’re four-inch heels—a four-inch difference between the back and the front, that’s a six-inch heel. You can do a lot of damage to your foot.
Bottom Line: Is there a maximum height, maximum differential in terms of how high a shoe should be?
Dr. Youner: The American Podiatric Medical Association agrees that two inches is about as high as you should go to be biomechanically stable in a shoe.
Bottom Line: All right. One of the backups is to wear platforms. I love this shoe. It has a platform, but it also still is quite high.
Dr. Youner: That’s probably a three-inch heel. Again, three-inch platform difference between the back and the front. There is no stability in the back, so again, you are running the risk of an ankle sprain or, worse, an ankle fracture.
Bottom Line: Does a wedge help better than a heel?
Dr. Youner: Absolutely. The weight is distributed better in a wedge. There’s more surface area.
Bottom Line: So all things being equal, pick a wedge versus a high heel.
Dr. Youner: Absolutely, a wedge or a platform.
Bottom Line: Let’s talk about my classic pump, because every woman has to wear just a basic heel.
Dr. Youner: I like the shoe. My only problem with this is the height of the heel, but this shoe has an adequately high toe box. The heel is a bit too high—it will set your body off and give you a little pain in the forefoot. But I think that’s a good shoe, especially if you’re not walking around a lot.
Bottom Line: You talk about a high toe box. What does that mean?
Dr. Youner: That’s the front of the shoe, where the toes are right there. Should be at least a half an inch—there should be room for your toes. If there is not, put the shoe down and walk away.
Bottom Line: So a high toe box means there’s room between my toes and the point?
Dr. Youner: Yes.
Bottom Line: Got it. Yeah, my toe doesn’t come all the way. Now how about very popular flats? Everybody says don’t wear heels, so basic little flats. I always try to give a break—actually, I alternate between heels and flats. So how about flats?
Dr. Youner: You’d be better served to alternate between heels and more of a wedge or a platform. Those ballerina flats with no support in them will cause you more problems, like arch pain, than any other shoe.
Bottom Line: Really?
Dr. Youner: Really.
Bottom Line: Can I put an insert in?
Dr. Youner: You can absolutely put an insert. There are so many inserts available. A ballet flat is not supportive and will cause you problems. It will create plantar fasciitis as well as a myriad of other problems. But a small insert like the Superfeet is readily available. It can fit right in there, and then you can walk comfortably.
Bottom Line: Should every woman have some kind of an insert, almost a wardrobe of inserts, that they either move from shoe to shoe or that they have in every fixed shoe that they own?
Dr. Youner: Absolutely.
Bottom Line: I have one more question. I’m wearing slingbacks, I almost forgot. Slingbacks—what about those? Good or bad?
Dr. Youner: Slingbacks are kind of in between. They are not supporting the shoe from the back. The heel supports the body in the shoe, so without a supportive heel, you’re lacking a little bit. I wouldn’t go for long walks, but they’re certainly pretty.
Bottom Line: Well, they’re comfortable. All right, so let’s talk about the Youner-approved shoe. What’s your rules for a shoe, just guidelines for what somebody should look for?
Dr. Youner: There are three things in shoes that one should look for. The shoe should have a firm heel counter…it should barely bend here…and it shouldn’t twist. So heel counter firm…should barely bend…and shouldn’t twist. This is three for three. This is a good shoe.
Bottom Line: And this is fairly stylish, kind of a nice casual shoe for weekends. It had a little bit of a heel, nice-looking shoe. So how about dress shoes? This was one. We talked about a wedge.
Dr. Youner: This gets the Youner approval. It’s about a two-inch or less heel with adequate room in the forefoot and enough surface area on the bottom that you’re not teeter-tottering on either the front of your foot or the back of your foot. So this gets three for three.
Bottom Line: How about boots? Boots are very, very popular.
Dr. Youner: Boots are very supportive, and a lot of people who have trouble with shoes can wear boots comfortably because of the support. So anybody that does not fit in a regular shoe, like a ballet flat, will be supported in a boot.
Bottom Line: Are boots in general good for people to wear in the winter, just in terms of providing more support and ankle stability?
Dr. Youner: Absolutely.
Bottom Line: When I was recently hiking, I was amazed. One day I wore high boots and one day I wore low boots. The stability—just even though my boots weren’t tied real tight, it was amazing how much more support that I had.
Dr. Youner: Boots are much better. The only problem people have with boots is when they get ingrown toenails, they don’t like the winter. Other than that, there are far fewer support problems with boots.
Bottom Line: Great. All right, talked a lot about women’s shoes. Let’s talk about men, because men in general don’t have as many problems, but there are a couple of things that aren’t so good. We talked about driving moccasins. What’s the problem with driving moccasins? They’re so comfortable.
Dr. Youner: There’s no support. So if you’re driving, I guess that’s just fine, but if you’re walking in them, you will create those problems of plantar fasciitis, bunions, you can sprain your foot. There is no support. The shoe twists in the middle. The 26 foot bones need support. If they’re not supported, you will sprain your foot.
Bottom Line: So same deal as women. Put an insert into the soft shoes, and then you can get away with this.
Dr. Youner: Absolutely.
Bottom Line: And on the good list for guys, I’ve got a loafer here. Loafer is good?
Dr. Youner: A loafer is a good shoe as long as the heel counter is firm…again, the shoe doesn’t twist…and the shoe doesn’t bend in the front. Some men require more stability, like a tie oxford for stability. But other than that, that has a nice high throat on the shoe—it’ll stay on the foot nicely.
Bottom Line: Women, we’ve got such a variety of shoes, but men often don’t have so many. Is it OK for them to wear the same shoe day after day?
Dr. Youner: People should change their shoes every day. If you only have two pair of shoes, that’s fine—one pair should dry and rest and have the shape maintained…then wear the other shoe the next day. If you keep wearing the shoes day after day, the shoe will deform, and your foot will deform and pay the price.
Bottom Line: Same rule of thumb with sneakers? They should have two different pairs of shoes that they alternate?
Dr. Youner: If you’re not wearing a sneaker all day, it’s not the same. If you’re just wearing it for the gym, it should be fine.
Bottom Line: All right. Thank you very much, Dr. Johanna Youner. The bottom line is, you can wear a stylish shoe that is good for your foot. Rules of thumb—make sure that the heel is two inches or less…have plenty of room in the toe box…you don’t want the twist of the shoe to be too great…and you want to have plenty of support in the heel.In addition, make sure that you get an orthotic or some kind of support that supports your arch. Then even the flattest of shoes will be able to give you support, and you’ll be comfortable and stylish. This is Sarah Hiner with Bottom Line Publications.
Source: Johanna S. Youner, DPM, a podiatric surgeon in private practice and attending physician at New York Downtown Hospital, both in New York City. Dr. Youner is a board-certified foot surgeon and a Fellow of the American College of Foot and Ankle Surgeons. Date: September 29, 2014 Publication: Bottom Line Health
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