Despite this inconsistency in shoe sizing, proper fitting best starts with some form of measuring (Fig. 6.1). It is best to then try on shoes that are made in three or four widths per half size and at a store with sufficient inventory to offer a wide variety of fitting choices. Unfortunately, most manufacturers make shoes in only one width and most stores carry limited inventory. This results in patients with wide feet frequently fit with shoes longer than needed to get the width they desire.

When shoes are correctly fit, there should be approximately ½″–5/8″ space between the end of the longest toe and the end of the shoe (Fig. 6.2). The shoe should be wide enough such that the foot does not bulge on the lateral side but not so wide that excess material can be pinched on top. Sometimes, after wearing shoes that fit short, the right size will feel too roomy. Generally, if shoes fit without slipping in the heel, then the bigger the size, the better.

Shape. It sounds simple enough, yet it is often overlooked how important it is to match the shape of the shoe to the shape of the foot (Fig. 6.3). Feet come in an infinite variety of shapes, yet shoes are mass produced using a limited number of forms called “lasts.” Lasts are designed to accommodate common foot characteristics including the breadth of the forefoot, arch morphology, instep height, toe depth, and heel width. Even if sized correctly, picking the wrong shoe shape will result in suboptimal shoe fit.

Most feet demonstrate a medium height arch, mild amount of in the transverse plane, and a broad forefoot. Such feet are best fit in shoes made on what is sometimes referred to as a “Universal” shaped last.

A segment of the athletic population has feet that demnstrate convexity in the transverse plane. Such feet are best fit with “Curved” shape lasts.

Feet that have low to flat arches require ample breadth in the midsection of the shoe. These feet are best accommodated with shoes made from what is sometimes referred to as “Linear” shape lasts.

Stability. Athletic shoe manufacturers promote stability in their marketing and promise such features as limitation of excessive foot motion to allowing feet to move as nature intended. They have developed a slew of design features to provide an appropriate combination of cushioning and control of foot motion. To determine a shoe’s stability, squeeze the sides of the heel counter, the rear part of the shoe. Stable shoes resist compression. Another test is to hold the shoe by the heel and at the toes and give it a twist. Torsionally stable shoes resist twisting; flexible shoes twist easily (Fig. 6.4).

The foot’s longitudinal arch helps absorb impact forces from heel strike to midstance. In the second half of the stance phase of gait, the arch normally rises, stabilizing the foot and helping it to propulse forward with an efficient, smooth gait. When the arch lowers following heel strike and rises again during the propulsive phase of gait, there is said to be biomechanically efficient gait and the foot itself is referred to as “Neutral.” During walking and running, athletes with neutral type feet contact on the lateral side of the heel, the rearfoot everts, or rolls towards the medial side, then resupinates through the propulsive phase of gait. Old shoes worn by “neutral” feet generally reveal wear on the lateral side of the heel and then even wear across the ball, sometimes continuing to beneath the distal medial aspect.

“Neutral” shoes, recommended for “neutral” feet, such are cushioned and flexible enough to allow the foot to progress naturally through the gait cycle. Neutral shoes lack extra pronation control features which could injure biomechanically efficient runners by limiting needed foot motion.

Many athletes demonstrate mild to moderate overpronation. Immediately after heel contact, such feet evert beyond perpendicular. While it’s beneficial that impact forces are dissipated by pronation following heel strike, excessive heel eversion can result in overuse injuries relating in strain to plantar-medial foot anatomy. “Stability” shoes are recommended for athletes who demonstrate moderate overpronation and who have low to normal arches. Such athletes generally benefit from shoes that feature a combination of good support and midsole cushioning.

Athletic shoe manufacturers incorporate an assortment of features designed to support the medial aspect of the heel, prevent compression beneath the plantar medial aspect of the sole and thus limit rear foot pronation (Fig. 6.5).

When there’s overpronation, after the lateral heel makes ground contact, the subtalar joint everts excessively, limiting shock absorbing benefits. Pes plano valgus feet make it difficult to run efficiently, frequently tire easily and are more subject to heel spurs, bunions, and medial knee pain. “Motion control shoes” are recommended for athletes with low arches who demonstrate moderate to severe overpronation, who need maximum rearfoot control and extra support on the medial side of their shoes. Supportive features include firm stabilization at the medial heel to limit heel eversion and a wider heel to provide stable support. This type shoe is also best for larger athletes who need support and durability.

Athletes with rigid, high arch feet that demonstrate minimum pronation are generally well suited for running fast but such feet offer limited shock absorption. These runners are usually midfoot or forefoot strikers and are more susceptible to impact injuries such as shin splints, stress fractures, and Achilles tendonitis. These athletes generally lack ankle joint dorsiflexion. Such feet are best accommodated in neutral-cushioned shoes as they feature maximum midsole cushioning and minimum medial support.

Style. There was a time when sneakers with canvas uppers and gum rubber soles were considered adequate for most any athletic activity. Today, shoes are manufactured for specific activities and surfaces using a slew of high-tech componentry (Fig. 6.6).