Four Essential Keys To Athletic Shoe Fit

By Josh White, DPM, CPed

For professional athletes and weekend warriors alike, having the right shoe and the correct fit can mean the difference between participating and sitting on the sidelines. Since most podiatrists now fit shoes in their offices, it is imperative that they develop a true expertise in this critical aspect of foot care, particularly with respect to the special needs of athletes. Providing proper shoe fit and selection for active individuals holds great potential for both injury prevention and for practice expansion. When podiatrists themselves fit patients with athletic shoes, it fills a void in areas lacking a shoe store with a large inventory and naturally offers greater profitability. Other podiatrists prefer to refer patients to athletic shoe stores. Such an approach typically offers patients a better selection and allows them to try on shoes in a relaxed, comfortable setting. Either way, the podiatrist ultimately needs to assess the functional biomechanics of the lower extremity, identifying its structural requirements and creating a plan to achieve the therapeutic objectives. Whether podiatrists elect to fit patients in the office or refer them to a store, they need to consider four simple but key considerations — size, shape, stability and style — to achieve the best clinical outcomes. When it comes to fitting shoes, choosing the right shoe size is deceptively complex. To start, manufacturers do not follow standards for length and width. Sizes vary not only between brands but also among different styles of the same brand. Sizes may even vary within a particular style if the shoe is manufactured by different factories. Despite this inconsistency, fit starts with measuring. Ideally, patients should try shoes that are made in two to four widths per half size at a store that stocks the various choices. Unfortunately, many manufacturers make shoes in only one width and most stores carry limited inventory. As a result, patients with wider feet frequently wear shoes that are too long in order to get the width they need. When the patient is standing, a properly fit shoe should have approximately a 1/2-inch to 5/8-inch space from the end of the longest toe to the end of the shoe. The correct width accommodates the foot without bulging on the lateral side and without excess material on top. Customers used to wearing shoes that fit too short often find that the right size feels too large. As long as the shoes do not slip in the heel, a bigger size is better. Why Shoe Shape Is So Important Many shoe specialists often overlook the importance of matching the shape of the shoe to the shape of the foot. While feet come in a variety of shapes, shoes are obviously mass produced with a limited number of forms called “lasts.” The lasts are designed to accommodate common foot shape characteristics. These factors include forefoot breadth, arch morphology, instep height, toe depth and heel width. Even when it is sized correctly, the wrong shoe shape still results in suboptimal fit. The following pointers on foot shapes and lasts accommodate most patients. • Most feet have a medium height arch with mild curvature in the transverse plane and a broad forefoot. Examples of lasts that best fit such feet include the “SL-1” from New Balance, the “Universal” from Brooks and the “Voyage” from Aetrex. • Part of the athletic population has feet that curve medially in the transverse plane. These lightweight shoes offer a snug, glove-like fit. An example of such a last is the “Curved” from Brooks. • Feet with low to flat arches need ample breadth in the shoe midsection. Athletes with these feet do best with shoes made on such lasts as the “Linear” from Brooks, the “SL-2” from New Balance and the “Lenex” from Aetrex. Inside Insights On Stability Athletic shoe manufacturers have seized on the concept of stability in their marketing and promise everything from limiting excessive foot motion to allowing feet to move as nature intended. Different features combine to balance cushioning and motion control, depending on the needs of an athlete’s gait. To determine a shoe’s stability, squeeze the sides of the heel counter, the rear part of the shoe. Stable shoes resist compression. Hold the shoe at the heel and at the toes, and twist.

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