We wear shoes for the protection of our feet but we buy shoes for their comfort and style! If you are a fashionista, you don’t have to give up those “stepping out shoes” but you do have to know the problems they can cause and think carefully about your feet and shoes.

Heather Abbott (Boston Marathon bombing victim) can walk in 10 cm high heels thanks to her specially designed prosthesis, mind you she does have 4 prostheses, and one for each type of activity she does.

What happens to your feet?

As an adult your feet get wider and longer with age or pregnancy. With SCI, or neuromuscular degeneration, muscles in the foot get thinner, but because you do not move much to help blood and lymph flow your feet also swell and get bigger during the day. Lack of movement may also result in stiffness at the joints. Poor sensation means you will not notice irritation or damage to the foot, which may lead to dangerous infections. People with diabetes or neuromuscular degeneration also get abnormal feelings such as a burning sensation, jabbing pains and tingling, even at rest. Arthritis can create deformities your toes and feet. When walking all your weight is supported by your feet, creating pressure or pain on movement. A lower leg amputation results in more body weight on the healthy leg, and as it will develop muscle bulk and spread the feet (so a bigger foot), and you may have arthritic changes in the knee and foot due to the weight shift.  So it makes sense to look after your feet and to do that you need well fitting shoes.

Top Tips for buying good fit shoes

  • Try on shoes in the late afternoon, as everyone’s feet swell during the day
  • Your feet are different sizes, so try both shoes on.
  • Standing (or leaning on your knees when sitting) creates foot “spread“. Allow for 1cm to a thumb width between your toe and the front of the shoe
  • Heels shouldn’t slip out of the shoe when you walk or transfer
  • Sizes vary across shoe brands and countries. A Size 37 in Europe is a SIze 4 in UK and a Size 6.5 in the USA. You can have a half size in length (many shop assistants are under the incorrect impression that the “½” is a wide fitting)
  • The widest part of the shoe should be around the widest part of your foot.  You should be able to wiggle your toes (if you can). Shoe width range from AA (narrow) and E and above (wide).
  • Try on shoes with the socks/tights/inner soles/orthosis you plan to wear with them as this changes the “depth” and “width” of your foot

Increasing the comfort level

Poorly fitting shoes cause pressure points leading to swelling, blisters, corns, ingrown toenails; which can lead to infection. Avoid shoes that have a “point” and go for “natural foot shapes”. High heels create pressure points on toes and ball of the foot and “flat” inner soles do not provide “arch support”.

Leather and cotton/canvas shoes and linings allow your feet to “breathe” so you sweat and swell less. They also “stretch”.  Most new shoes have a tag on the underneath that tells you about the material.  Be wary of Pleather (which is a plastic).

Shoes with padded inner soles are more comfortable. Rubber soles with “tread” give better grip than leather soles when walking or keeping your feet on the footrest.

Solid shoes protect against injury better than sandals but can be hot. Sandals may be more comfortable if you have feet that swell during the day. Thongs rub against toes. If you are accident prone, look for harder leather in front of the toes for protection.

Shoes with larger openings are easier to put on and take off, and adjust for swelling, that’s why orthopaedic shoes often have laces, straps or buckles. Other ways to cope with swelling feet are:

  • Lighter colours absorb less sun
  • Buy shoes 1-2 sizes bigger 
  • Instead of throwing out your old shoes, take out the inner sole and see if that helps adjust your size - be wary of exposed stitching.
  • Use inner soles to take up the “slack” when your feet aren’t swollen e.g. in winter.
  • Use different thickness socks. Light cotton socks are sold by department stores in summer and heavier, thicker wool socks in winter. For luxury treat yourself to mohair or silk socks. Natural fibre socks help with preventing sweat and build up of bacteria. “Secret socks” have a tendency to roll down your foot and can cause pressure points. Avoid socks with hard seams across the toes and strong elastic. Try “terry” socks, sports socks or special socks for diabetics.
If you don’t want to give up your fashionista shoes, then make sure you do a daily foot check, deal with foot problems quickly and give your feet a fashion break every day.

Off the shelf “orthopaedic shoes”

These provide padded soles and arches, have no inner stitching, and are made to a high standard from natural materials so they are less likely to create common foot problems from rubbing and weight shift. They now include flat and “fashion” styles from South African brands such as Froggie, Tsonga, Green Cross, and Grasshopper. Good quality trainers and hiking boots use the same principles, especially trainers with “shock absorbing” soles. More traditional orthopaedic shoes are available at Pharmacists, Health shops and Podiatrists.

Advice for specific disabilities

Podiatrists provide expert advice on feet, often essential for people with diabetes. Assessment includes 3-D measurements, foot scanning for pressure points, analysing standing and walking, and the right shoes and prescription inserts for your foot. If you “toe in” or have ankles that turn in or out they will help you with inserts or recommend specific soles designed for these problems.  If you have really odd feet you can get adapted shoes or made-to-measure shoes from a podiatrist or orthotist.

Have arthritis? Look for cushioned inner soles, arch support, easy fitting and fastening, rocker soles for “push off”. Avoid narrow shoes, stitching, and heels over 2.5cm. Proper shoes can help prevent foot ulcers in diabetics.

Swollen feet? Look for shoes made of mesh and adjustable fastenings. Avoid narrow widths, open toes or heels, and shoes with over 1.5cm heels.

In a wheelchair? A good shoe makes you look and feel good. The advantage is that your shoes will not wear out quickly so why not splash out? Pam Hill bought shoes from Richard Kushlick in 2002 and has been really happy with the fit, comfort and support they give her when walking with her crutches (she has SCI), and they have lasted a long time!

Only 1 leg? Antoinetta Oosthuizen has set up “A Single Shoe” for selling odd shoes, and Rogue shoes will sell you 1 shoe at a time.

Looking after your feet and shoes:

Foot care:

  • Wash daily in warm water
  • Dry carefully
  • Cut toenails short and straight
  • Use lotion (this can prevent foot ulcers by 3:1 in diabetics) and sunscreen protection
  • Wear natural fibre socks
  • Daily foot inspections as injuries are slow to heal so the quicker you find them the better. 
  • Don’t go barefoot
  • Check the shoe’s inner lining is intact
  • In a wheelchair? Use the foot rests so your feet do not drag, and wear shoes to protect your toes.
  • Daily foot inspection getting out of bed or washing your feet check for:
  • Red and peeling skin between the toes, and burning and itching feet if you have sensation. Athlete’s foot may trigger dysreflexia in SCI.
  • Sores, blisters, splinters, and cuts that may trigger ulcers and sepsis in diabetes and SCI  (pressure sores are ulcers on bony parts of the body)
  • Red skin shows pressure point.  Red, hot skin means an infection.
  • Cold and white or purple/blue skin means poor circulation. Purple skin needs to be checked at a clinic or doctor
  • Swollen, shiny skin is cellulitis
  • People with diabetes may have dry itchy skin
  • Ridges, white spots, dents, splits, thickening, or bulging of the nails may be due to injury, illness, vitamin and mineral shortages, or side effects of a drug
  • If there is a problem deal with it quickly.

Can’t see the bottom of your feet?  Put a small mirror on the floor and hold your foot over it.

Prevent bacterial build up in shoes by:

  • Changing shoes daily
  • Dry out overnight by using talcum powder, silicon bags (found in pill containers), small material bags of bicarbonate of soda, or wipe the inside of your shoes with vinegar & water.
  • Polish your shoes to keep them soft and rain protection
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