Are Your Shoes Killing You?

During my early years of practice, while working with youth sports, I met an Athletic Trainer named Bob Ragsland (“Rags”). He had been working with college athletes for many years and emphasized to me the importance of proper equipment fitting. I spent many hours with him learning techniques for fitting shoulder pads, helmets and other sports equipment.

Then, one afternoon at a Pop Warner football game, a mom came up to me and asked if I would look at her son’s feet. She stated he kept spraining his ankles and was always complaining about foot and ankle pain. I noticed that, indeed, both of his ankles were swollen and very tender to touch. Thinking it was odd for both feet to be like this, I asked to see his cleats. She showed me a pair of football cleats that were about as useless as running with plastic bottles on your feet! The “cleats” were ¼” stubs about ½” in diameter that provided no traction whatsoever. Not only that, there was no lateral support and they were about two sizes too big for him. The salesman had assured her, “These are the latest…blah, blah, blah.” 

The shoes were not new—hence, the ankle sprains—but I told her to take them back to the store and complain that they were injuring her son’s feet. I told her what kind of football cleats to look for and the kind of lateral support he needed. Then I asked her why they were too big for him.

She told me her husband wanted to buy them large enough for him to “grow into” over the next year or so. I told her I thought that was a very bad idea and she should fit the shoes to his feet for this season. Another danger with cleats like these is they will give the young athlete a false sense of security in thinking they can “run and cut” at full speed without injury.

This incident started me thinking about footwear for all of my athletes and I started checking shoes regularly. The more I checked, the more problems I found, not only with cleats but also with running and other types of athletic shoes. The photos presented here are of shoes and cleats I checked recently from about a half dozen very well known shoe outlets. In every case, I asked the sales representative to bring me several pair of their most popular brand name shoes. I did not sort through any boxes trying to find “problem” shoes. As a matter of fact, I spent two days searching for one good pair of shoes I could show as “normal” but, after looking at well over forty pair of shoes, I was not successful!

We will start with cleats for kids. Everyone knows how important proper footwear is, especially for kids. So, when you go to the shoe store, the first thing I want you to do is ask the sales person to bring you three pair of the same shoe. They’ll look at you kind of funny, but so what; it’s your money. Find a nice flat counter (move some of the display shoes out of the way if necessary), line the shoes up side-by-side, stand behind the shoes and look at the alignment. Figure # 1 shows a bright blue pair of girl’s Nike soccer cleats.  Look closely and you can see that the right shoe is slightly higher than the left. This may be a little difficult to see here but, when you’re at the store, it jumps out at you when you start to examine shoes. Now, notice that the left shoe tilts outward slightly. The problem here is, over the course of an entire season, as these shoes break down, this young athlete is going to develop any combination of foot, ankle, knee and back pain because the right shoe is too high and the left shoe is tilted outward, precipitating inversion ankle sprain.

Figure # 2 is a pair of boy’s black Adidas football cleats. Again, you can easily see how much taller the right shoe is compared to the left. If you look closely at the logo, you can see the difference. At least these shoes are not crooked. However, over an entire season, these will cause lower extremity and back pain due to pelvic tilt and imbalance.

Let’s move on to athletic shoes. Figure # 3 shows a pair of black running shoes with a white stripe down the center of the heel. The left shoe is much higher than the right, at least ¼”, and this shoe also tilts inward significantly, which places powerful lateral pressure on the ankle, precipitating inversion of the ankle. In addition to this, look how the left lateral heel base raises up higher than the right. This shoe is a disaster waiting to happen! If the person who buys this pair of shoes is a serious runner, he or she will develop serious lower extremity and back pain.

The next pair, Figure #4, is just the opposite. The right shoe is slightly higher than the left, but the left shoe tilts outward. Running in this shoe will place significant medial pressure on the ankle, precipitating eversion (pronation) sprain.

Figure # 5 is two views of the same shoe: A. From behind and B. From the top. These are Nike shoes. The right shoe is high and the left shoe is tilted outward; but look at View B. The left shoe is a full size longer than the right! What happens if this person is wearing the short shoe on his or her long foot? Right! He or she will have foot and toe pain and pain in the ball of the foot. OK, what if the person has his/her short foot in the long shoe? Can anyone say, “plantar fasciitis”? Are you getting this? Can you see how important proper footwear can be, not only with serious athletes, but with your everyday patients who wear tennis shoes to work or the weekend athlete who spends $100 on a pair of running shoes only to develop foot and back pain?

For more than thirty years I have been checking shoes and, I’m sorry to say, at least 50% of the shoes I check have problems in their construction. The only “quality control” I have been able to find is a person who stands at the end of an assembly line and makes sure there is a left and a right shoe in each box. What to do? Remember when I said to ask the sales person for several pair of the same shoe?

Look at Figure # 6, the Speedo shoes. The right shoe is badly tilted, but the left shoe looks pretty good. Now, I’m going to take a right shoe from each of the other boxes and try to make a match for the good left shoe. If I can make a good match where both shoes are equal in height, width, length and alignment, I tell the sales person, “This is the pair I’m buying.” Salespeople don’t care; they just want to make a sale. If I can’t make a good match, I either change brands or go to a different store. When my kids were growing up, I can’t tell you how many times we spent an entire day going from store to store trying to find shoes that would not ruin their feet. 

Here’s more bad news. Orthotics will not help this at all! If anything, trying to make orthotics to correct this problem will only make it worse. Have you been in a situation where you have had to make two or even three pair of orthotics for the same problem, only to have the patient go elsewhere in frustration? Maybe it was the shoes! I am all for orthotics under the right circumstances; but let’s get started on the right foot (bad pun) to begin with! Any athlete coming to me for treatment is automatically told to bring “all of your running or athletic shoes” to the office on the next visit. Yes, this does take a few extra minutes, but the patients love the attention. “No one has ever done this before!”

There are several shoe stores in my area that, when the patient brings the shoes back, the salesperson says, “Oh, you must go to that chiropractor.”
This is great, because it saves a lot of time. They just give the customer a new pair of shoes with no question. Once you get used to checking shoes, you will become the shoe expert in your area.

Couple of other points I want to make: The cost of the shoes has nothing to do with the quality of construction. I was at the Costa Mesa, CA, Bally store and saw a pair of badly made running shoes with a $450 price tag. On the other hand, I have found perfectly made shoes at Payless for less than 10% of the Bally shoes.
For walking and general exercise, the best-made shoes I have ever found, and use myself, are skateboarding shoes. Someone told me once that these shoes are all made in the US. I’m not so sure about that, but I do find these to be very well made.

Invariably, I have patients or doctors ask, “Well, what about leather dress shoes or high heels?”

Very rarely will you ever find a problem with this kind of footwear. (I can hear a great sigh of relief from all of the women doctors out there.)

Dr. Le Beau practices at Chiropractic Industrial and Sports Center; 1365 West Vista Way, Suite 100; Vista, CA 92083. 

Send your questions to Dr. Le Beau, send them to him at [email protected].

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