How to pick a Good Shoe

A stable shoe is essential for the effective functioning of an orthotic device as it provides a firm and consistent foundation that supports proper foot alignment and biomechanics. Stability in the shoe helps to evenly distribute body weight, minimizing localized pressure and reducing the risk of aberrant forces that could lead to discomfort or musculoskeletal strain. Without adequate stability, the orthotic may not properly align the foot and ankle, impairing its corrective function and requires us to “overcorrect” with our orthotic which could result in a heavier and bulkier orthosis. Additionally, a stable shoe minimizes movement or slippage of the orthotic, ensuring that it maintains its intended therapeutic benefits while enhancing overall foot health and postural integrity. 

At the bottom of the article, we list some shoes that have the features we are looking for. However, we will also describe how you can perform some shoe assessments on any shoe you come across to see if it is the right fit for your orthotic.  

Key Features in shoes  

Sole stiffness 

A nice soft shoe that offers cushion with every step feels nice walking out of the store, However, when thinking about what shoes to wear with orthotics, we often favor models with a stiffer sole. If you are wearing an orthosis, your feet need corrective positioning due to biomechanical malalignment. This might mean that you are placing excessive pressures on your shoes, causing uneven wear and deformation.  

The chart below describes some common lower limb malalignments:

When testing the stiffness of the sole, if you can squish out the heel to one side or the other then it may be too soft. If the foam of the shoe easily deforms under your weight, then it may not provide enough resistance to your biomechanical malalignment even with an orthosis. 

Heel is too soft. Heel squishes out easily and will not provide stability to someone with moderate or severe biomechanical malalignment

Over time, this will result in a deformation in your shoe that is undesirable for the base of an orthotic device and will provide suboptimal biomechanical correction with your orthotic treatment.  

Looking at a pair of my own shoes, you can clearly see where I have squished out the foam of the soles. You can also see which foot pronates and which one supinates. This places the whole shoe at an angle that worsens when you bear weight on the shoe. Therefore, even if I have an orthosis inside of the shoe, the shoe itself is not neutral and contributes to my malalignment when standing and walking.  

Shoes that have been worn unevenly

Flex point  

The flex point of a shoe should align with the metatarsal heads (the ball of your foot) to ensure natural foot movement during walking or running. This allows the shoe to bend where the foot naturally flexes, promoting proper gait mechanics. A shoe that is easily deformed andcan be wrung out like a towel lacks the necessary support and control to resist malformation of the shoe.  

Sole stability  

Designs and midsole cutouts that compromise the shoe’s structure can weaken stability by reducing the firmness and support of the sole. These cutouts often create areas of instability, making it harder for the shoe to maintain contact with the ground and decrease your base of support. As a result, they can interfere with proper foot alignment and increase the risk of misalignment or injury during movement. Stability is best achieved with a solid, continuous midsole that supports the foot throughout the gait cycle. 

Stable sole 

Toe box  

A wide and deep toe box is crucial for orthotics and toe conditions/ deformations as it provides ample space for the orthosis to fit in the shoe while still allowing a comfortable amount of space to move your toes around. This extra space reduces pressure on the toes, helping prevent or alleviate conditions like bunions, hammertoes, or other deformities. When the toes have room to spread naturally, orthotics can function more effectively by supporting the correct foot position. A tight or narrow toe box can exacerbate deformities and decrease the overall comfort of the orthotic.  

Lace up/ Velcro 

Lace-up and Velcro shoe closures are more adjustable than elastic or slip-on shoes because they allow for a customizable fit. Lace-up shoes can be tightened or loosened at specific areas of the foot, offering greater control over the fit across different foot shapes. Similarly, Velcro closures can be easily adjusted to accommodate changes in foot volume or swelling. In contrast, elastic and slip-on shoes provide a more relaxed fit, which may not offer the same level of comfort or support for individuals with varying foot conditions. However, we do realize that slip on shoes are easier to put on than their alternatives. Therefore, other options that can help make putting on your shoe and orthosis easier are elastic shoelaces and zip-up accessible shoes like the Billies brand.  

Shoe Size/ Width  

Any shoes that you wear with your orthotic will need to fit both your foot and orthotic. This can mean up to 1 cm of extra space all around your foot. If your shoe is already tight without an orthotic, consider buying a half size or one size larger as it will provide a more comfortable fit. If you have a wide foot, also consider buying a wide or extra wide shoe designation as we need space on either side of the foot to provide optimal support with our orthoses.  

Removable insole 

A shoe with a removable insole is necessary for orthotics. A removable insole ensures that we have the necessary room to insert our own custom made orthotics in your shoe. Some shoes with extra depth will come with 2 or more removable insoles. This is ideal for anybody who has swelling in their feet, for people who have high arches, or for people who have pain due to overlapping toes. A thicker insole (>4mm) is always better for people who already experience tightness in their current shoes. This helps us to avoid any potential problems during orthotic fittings by providing us with extra room. More room will also make it easier for you to put on your shoes when you receive your orthosis. 

Rocker sole  

Rocker soles are a type of shoe sole design intended to facilitate smoother and more efficient movement by promoting a natural gait and reducing stress on the joints. These soles are typically curved along the longitudinal axis, with specific sections of the sole raised to create a rocking motion during walking. Rocker soles are useful for people with less joint movement at the hip, knees, ankle, and forefoot.  

Different Rocker Soles

However, if you have poor balance or ankle instability, a rocker may be contraindicated for your needs as it is not as stable as a flatter sole. A flatter sole is more stable and will provide a better base of support. A flat stable shoe might be better for people who are hypermobile or suffer from frequent ankle sprains. A rocker sole facilitates forward motion; therefore, it may not have a stable area which might feel unsafe for some users. Before buying a rocker sole shoe, make sure to try them out in the store first to see if you are comfortable and safe wearing them.

 Accessible and Orthopedic Shoe recommendations