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If the Shoe Fits

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"I can’t find shoes that fit my feet.”

“I spend a lot of money on shoes.”

“I was told I needed these kind of shoes.”

“I try to wear good shoes.”

These are comments Dr. Crystal Dickson, foot and ankle specialist at Sentara Martha Jefferson Orthopedics, hears frequently.

The United States has the largest footwear market in the world, amounting to approximately $79.86 billion in revenue in 2017. As of 2017, the average selling price of a pair of athletic footwear was $58.16. That’s an impressive shoe budget.

On the Run

In the past century, running shoe designs have experienced dramatic changes.

“The running shoes in 1912 were shoes that would be considered more of leather-type dress shoes today,” noted Dr. Dickson. “Today, athletic shoe companies spend a lot of time and money to research and market shoes described, for example, as supportive, cushioning, lightweight, minimalist, and barefoot.”

While a 2019 runner would not consider using a running shoe from the early 1900s, there remains the question of whether or not today’s shoe design can decrease injury rates.

“To date, impact and foot position have not been found to predict running injuries,” said Dr. Dickson. “However, some shoes can change the range of movement. Theoretically a ‘good’ shoe helps keep the body in a preferred movement path. The trick is that it is difficult to assess whether or not a shoe supports the preferred movement path.”

In recent years, there has been a movement toward barefoot and minimalist running. Advocates assert that a lack of cushion and support promotes a forefoot or mid-foot strike rather than a rear-foot strike, decreasing the impact and stress on the hip and knee. This change in gait is only theorized to decrease injury risk and the concept has not yet been fully elucidated. Research has shown diminished symptoms of chronic exertional compartment syndrome and anterior knee pain after a transition to minimalist running. But studies have shown that with the transition to minimalist running, there is increased stress on the foot and ankle and risk of repetitive stress injuries.

There is still a large gap in evidence-based knowledge in regards to minimalist running. At this point in time it most likely boils down to how disgusting one thinks walking or running in bare feet is. Pink sands of Bermuda — yes. Sidewalks of New York City — No.

What about High Heels?

In studies, high-heeled shoes have been shown to be associated with bunions, musculoskeletal pain, and injury to the wearer of the shoe. No conclusive evidence regarding osteoarthritis and second-party (those around the shoe wearers) injury was found. So should one avoid wearing high heels — yes.

“A recent study showed that in women, compared to ‘average’ shoes, those who wore ‘good’ shoes in the past were 67 percent less likely to report hind-foot pain,” explained Dr. Dickson.

“Good” shoes consisted of low-risk shoes including athletic and casual sneakers and “average” shoes were hard or rubber soled shoes, and work boots. In men, there was no association between foot pain and footwear, likely due to the fact that less than 2 percent wore bad shoe types (high-heeled shoes, sandals and slippers).

“So yes, wearing good shoes are better for you, but we did not need a scientific study to tell us that — just common sense,” added Dr. Dickson.

If the Shoe Fits

So Dr. Dickson’s in response to those comments she often hears from patients:

“I can’t find shoes that fit my feet.”

Keep trying. If you still can’t, you likely have a structural issue we can work on.

“I spend a lot of money on shoes.”

You don’t need to.

“I was told I needed these kind of shoes.”

That’s just not true.

“I try to wear good shoes.”

Good job - continue to do so.

Dr. Crystal Dickson

For more information, visit Or call 434-654-5575 to schedule an appointment.


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