As an orthopaedic surgeon fellowship trained in foot and ankle surgery I get to see all types of feet. I see dancers with mangled toes and callouses, basketball players with flat flippers for feet, and runners with tortured heels and arches. Albeit, by the time you’ve come to see me you’re probably dealing with some sort of pain.
When it comes to the painful foot I often discover that the shoe type AND foot type has led to significant problems. This can be related to the construction of the shoe (or wear and tear), your natural alignment given by your parents, or a deformity that has been acquired over years of pounding. For instance, the minimalist shoe movement led to a boost in my practice as many people have feet that can’t handle the stress. The “terrible too’s” of doing too much, too soon, and too quickly leads to a recovery debt and a build-up of mechanical stressors that causes stress fractures, hammertoes, metatarsalgia, plantar fasciopathy, and tendinitis.
The painful foot needs to recover. When patients present with exquisite pain with limping my hand is forced to put them into a rockered-cam boot. Similarly, if you are having significant pain from any of the above conditions I will recommend a “recovery shoe”. This is a shoe that gives maximal support with rigidity, motion control, and even a rocker sole. They may not need to be in a shoe of this type forever, but it will help them recover. Once one recovers from pain and/or injury, the next question that always comes up is “What shoe type is appropriate for my foot?”. This again is not a simple question to answer as the jargon about shoes can be very jumbled and running store salesman often get the foot type wrong. Shoe companies like to throw out terms like stability, motion-control, cushioning, minimalist, neutral, etc… keep things more simple.
I like to define foot types as flexible, rigid, or pathologic. Of course, there are many types in between and one may even have a “neutral” foot. The “neutral” footed person with a “normal” arch is the most confusing type, so I would suggest accessing your foot flexibility. The Flexible Foot:
The more flexible foot is a foot that has some ligament laxity and tends toward a flatter foot. A flat foot is often called a “pronated foot”. Pronation in the foot is similar to pronation in the hand. Pouring a bowl of soup onto the floor takes pronation of the wrist. In the foot this would be like everting the ankle and pushing the great toe (medial foot) into the ground. In other words: forcing flattening of the arch. As you can imagine this puts a lot of stress on the great toe and 2nd toe. This can lead to further instability of the 1st metatarsal and 2nd toe causing a bunion and/or 2nd hammertoe. As a bunion becomes more prominent the foot becomes more flexible or unstable.
The Rigid Foot:
The rigid foot is a foot that had a very solid shape that deforms very easily. This is a great foot type for great push-off strength as it acts as a powerful lever-arm for the calf muscles. This is the “supinated” or high-arched foot type. Just like holding a bowl of soup in the hand, if you try to lift your arch to do the same this is foot “supination”. The rigid foot can often lead to callouses from pressure points, more of a tendency to put stress on the ankle (even ankle sprains), and can lead to more pressure on the toes. Supinators tend to have strong and tight calves and often run on a midfoot/forefoot strike pattern more like a sprinter.
The Pathologic Foot:
This is the foot that has muscle imbalances that present themselves more with walking, running, or jumping and are often a result of pathologic conditions of tendons, ligaments, or bone. This is often a painful foot. It may be an excessively rigid or “cavus” foot type that causes 5th metatarsal stress fractures and ankle sprains from walking/running on the lateral border of the foot arising from over-pull of the peroneus longus and posterior tibial muscles. This could also be the severely abducted forefoot with severe flattening from a dysfunctional posterior tibial tendon and spring ligament. As mentioned above this foot type may require aggressively stable shoes with special inserts or braces.
Deciding on a Shoe Type:
If you have a non-pathologic “neutral” type of foot that is pain free you can really just pick a shoe that you find most comfortable. That being said, your shoe choice is going to have to be very dependent on your previous level of running exposure. If you are just starting out, I wouldn’t recommend going with the lightest, minimalistic, and flexible shoes. This is most-definitely a recipe for the terrible too’s and the problems that come with it. I recommend starting with more supportive and then gradually trying less rigid or lighter shoes as you build up durability. Try alternating from supportive to lighter shoes using a break-in period of about a month. Once you find that the less rigid shoes are comfortable you can go full time. If you have a very flexible foot that “pronates” or flattens easily you also need to consider a shoe that is more rigid and supportive of your arch. Flexible needs rigid and rigid need flexible. Do my “Two-Finger” Test and try to flex the sole. If the shoe bends at the toe or even the arch it is too flexible for you. The shoe should have a little more rocker to the sole when you set it on a table. Also, try twisting the shoe holding the heel and the toe. If your foot is very flexible, your foot will flex easily the same way. Give your foot stability with the stable “motion-control” types of shoe. The Hoka Bondi 8, Brooks Ariel or Beast, New Balance 1540 are starters.
For the rigid foot type that tends to “supinate” it is often recommended that you look for a “cushioning” type of shoe. However, many people misinterpret this as a very light or a minimalist shoe. In fact, because of the rigidity of the foot and the bony prominences this foot type needs a sole with thicker cushion although the shoe can be flexible. This foot type may do well with a stable motion control type of shoe if it is heading toward pathologic or has a history of ankle sprains. The Hoka Clifton may be a less rigid, but cushioned shoe to try. Higher arches may irritate the top of your foot in shoes, so consider skipping the crosses in your laces by a couple of holes to leave room for the top of your foot.
