About Shoes

Call Us: 916-488-1478

Streamline Orthopedic, Inc.

About Shoes:

Let us help you choose a shoe that best fits your foot type. If you have any experience with orthopedic or extra depth shoes, then you probably know one shoe manufacturer's "extra wide" can fit like another's "medium". This can be especially frustrating when ordering shoes online and can lead to unnecessary returns.

As a Certified Orthotist and Certified Pedorthist, we make specialty foot/ankle braces known as AFO's and custom foot orthotics. We fit shoes to problematic feet every day. After a combined 35 years of experience fitting shoe to very challenging feet, we feel compelled to share what we consider to be the most important things to know about fitting shoes.

DO YOU REALLY KNOW YOUR SHOE SIZE?

If you have ever had your foot measured on a "Brannock" foot measuring device, remember this was just a starting point for the shoe salesperson. Your proper shoe size in any particular shoes may be much different than that measurement depending on the brand of shoes and its volume characteristics.

When standing in your shoes with your toes relaxed, there should be no less than 1/4 inch of clearance from the longest toe to the end of the shoe. The biggest mistake people make when checking this, is lifting their big toe to the top of the shoe. This always makes the shoe look longer than it really is compared to the relaxed toe.

Running shoes should have 1/2 inch or more clearance to the end of the shoe because the foot will elongate more at higher impact. We always recommend at least 1/2" of clearance or more to the diabetic patients with neuropathy since they may not be able to feel a potential toe-rubbing problem until it has caused a skin ulcer.

If you currently have a shoe that has its own removable insole, take it out of the shoe and place your foot on it. If you can see much of your foot beyond any part of the insole, then you are probably not in the right shoe. Calluses or redness on the big or little toes are good indicators of improper shoe fit.

THE THREE MAIN CHARACTERISTICS OF A SHOE THAT DETERMINE ITS OVERALL VOLUME CAPACITY ARE: LAST, DEPTH, AND ELASTICITY. Let's take a moment to familiarize you with the words LAST, DEPTH, and ELASTICITY.

LAST:

Shoes are built around a model shape known as a last. For example, orthopedic shoe manufacturer, P. W. Minor, categorizes their shoes according the last they are built around. Their Summit last means the shoe narrows to a point beyond the toes. There are many variations of points with some rounder and broader than others.
Contour Last: These shoes do not come to much of a point and have also been referred to as euro or wedge toe shoes. Their broad toe box is most obvious and sets them apart from other shoes. They are extremely comfortable for people with wide feet and those with pressure problems on the side of the big or little toe.
The Anatomical Shoes Last: Getting more popular everyday, this type of shoes has an obvious wider toe box that looks more anatomically like a real foot and often has a wider base of support. Check out Drew Toledo for men. They are stylish, light-weight, and have extra depth. Best of all they are shaped to the natural toe spread of a man's foot.
Orthopedic SL3 Last: The majority of athletic shoes found on sale at department stores do not have toe boxes wide enough for problematic feet. New Balance offers widths up to 6E, but more important is their Orthopedic SL3 Last, which provides a much broader and rounder toe box. New Balance offers these wider lasts on its 928 and 813 walking shoes and on select running shoes like the 1540, 1340, and 1012. Department stores and outlets are less likely to offer these higher-end models than are specialty or orthopedic shoe dealers.
The last is probably the most important thing to consider when choosing the appropriate shoe. So take an honest look at your bare feet and determine which last would best fit your feet.

DEPTH:

Depth is a vertical (up down) measurement and extra depth or added depth is the extra amount of internal vertical space beyond what a regular shoe has. It is usually about 1/4 to 3/8 of an inch.
Sometimes manufacturers will use terms like: double extra depth or super depth which provide about 1/2 inch of additional internal vertical space. These shoes work well for people with clawed or hammer toes and people with rigid cavus feet or very high insteps. They also work very well with AFO's and thick, full-length foot orthotics. Because of their extra overall volume, these shoes tend to run very big.

ELASTICITY:

Severe bunions, hammer and clawed toes or other foot deformities can make for very difficult shoe fittings. This is where shoes with elastic uppers come into play. Shoes with trueelastic uppers or "stretchers"will usually stretch to accommodate most any deformity with very little pressure to the skin. See Dr. Comfort shoes "Annie" for woman and "Brian" for men.
The same concept applies in a lesser degree to shoes made of soft forgiving materials. Generallynubucksand suede types of shoes (See Orthofeet stretchable shoes and Drew nubuck shoes) will not feel as snug as the same shoe in leather. There is less risk of skin breakdown with these softer materials, although they may not hold up as long as standard leather shoes.

Where should a good shoe fit snug?

The heels and midfoot of a shoe should be the main areas of pressure. The metatarsal heads and toes should not be taking any pressure, and you should be able to spread your toes easily inside the toe box.

Why is an arch (heel to ball) measurement important?

Some shoes are built to fit that arch length exactly and this can affect where the shoe bends on your foot as the heel comes off the ground. Arch measurement is definitely something to consider along with the typical heel to toe measurement, but rule of thumb is to make sure the widest part of the foot, the metatarsal heads, are in the widest area of the shoe before it starts to taper towards a point.

The ideal foot does pronate or supinate.

Pronation means the foot structure collapses to absorb shock at heel strike. The heel goes into an evertedor valgus position, the midfoot bones disengage and the forefoot abducts.
Supination means the foot structure becomes rigid to support all of the body weight while the other foot is swinging towards advancement. The heel goes into an inverted or varus position, the midfoot bones re-engage, and the forefoot adducts.
Most foot orthotics are made to control over-pronation or failure of the foot to get rigid or re-supinate when it is supposed to. A supinated foot after heel strike gives balance and stability.

Gait cycle

A pattern of walking that repeats itself. The act of falling forward and then catching yourself which normally starts and ends at heel strike of the same foot you started on. Heel strike is almost always on the outside edge of the shoe regardless of whether you have tendencies to over-pronate or over-supinate. This tends to be the first area of the shoe to show a wear pattern.

The subtalor neutral (STN) foot

This is an old podiatry term that basically means the heel is aligned directly below the ankle. It is in neutral. A pronated foot has an everted heel and a supinated foot has an inverted heel. Since the STN foot is neither pronated or supinated, it is often used in foot orthotics as the model of a balanced foot.

Heel Counters

This is the back part of the shoe that keeps the heel stable. A snug, rigid heel counter will help hold the heel more vertical and lead to decreased pronation. Using a shoe with a soft or non-existent heel counter will severely decrease the effectiveness of a foot orthotic since both the heel counter and the foot orthotic work together to keep the heel neutral.

Motion Control

A term used by New Balance to signify a shoe that has a wider base of support. The shoe is more rigid and will control excessive pronation. Most good athletic shoe lines will offer similar versions of these maximum support shoes.

Rollbar

A term used by New Balance to signify a rigid, carbon graphite material sandwiched within the sole that keeps the shoe stiffer at the heel and midfoot. Shoes with rollbars help to control over-pronation. A good rollbar will prevent the shoe from bending at the midfoot and allow the shoe to roll forward with much less bending pressure on the metatarsal heads and toes.

Rocker Soles

This is one of the most ambiguous terms in the orthopedic shoe business. In its most general meaning, you can think of a rocking horse or the bottom of a rocking chair. This half-moon round shoe soling equates to the foot and ankle not having to bend as the body weight goes over the foot. Instead, the body essentially "rocks" over the foot. The concept is great for people with arthritis and/or ankle fusions because this puts less stress on the ankle/foot complex.
Some extreme rocker-soled shoes are made exactly like this half-moon rocker; however, they can be hazardous and many people have fallen backward on these. They can also be very heavy, bulky, and stiff.
Most orthopedic shoes that advertise rocker soles have mellowed out the rocking-horse concept to mean that the shoe has a slight roll at the back of the heel and moderate roll at the toe.
Xelero shoes, for the most part, have excellent rocker soles. Some wider-based New Balance models with rollbars and motion control will usually have a more notable rock compared to the others. These shoes are stiffer soled and will only bend slightly at the toe break. This makes the rock work more effectively. New Balance doesn't advertise their shoes as having "rocker soles." Many other orthopedic shoe companies that do advertise having "rocker soles" often have far less effective rockers.

Where should a good supportive shoe bend?

If you try to fold a good orthopedic shoe in half, it should only bend at the toe break.

What shoes are good for feet that over pronate?

Look for a wide-based shoes that has solid foundation under the arch. If you can see a gap in the midfoot that is between the heel and forefoot soling, the shoe will most likely bend there and allow more pronation.
Watch out for shoes with rigid arch reinforcement and narrow base of support. While these shoes may feel comfortable and supportive on their own, the addition of foot orthotics often leads to discomfort directly under that rigid reinforcement.

What shoes are good for feet that over supinate?

Wide-based shoes with lateral flares will help over-supination or a varus foot. Think of the lateral flare as a kick stand on a bike. Running shoes often have lateral flares, but for the most part, athletic shoes are built for neutral feet or pronation control. Rigid, cafus feet need shoes that have rigid soles to prevent the shoe from distorting and leaning outward, but they should also be well cushioned internally to protect the foot from impact.

Gels and air soling

While these very light-weight shoes may seem comfortable at first, they tend to compact out prematurely, especially at the lateral heel, leaving the shoe with an obvious outward lean. Many runners with knee problems can trace the origin back to gel or air-soled shoes. These shoes generally do not do well with foot orthotics since foot orthotics require a firm, level foundation.