By Dr. Steven Gershman
Growing up and now as an adult I always had trouble finding comfortable shoes. When I was young, I had no idea shoes had different widths and no shoes ever felt good. Later on, I found shoes with wide width labels and that changed everything. My comfort level improved dramatically. However, it wasn't until much later in the 1990's that I truly found extra comfortable shoes. That is when Orthofeet started manufacturing shoes to go with their excellent inserts/orthotics that I was already using. What made the difference? SHAPE, what I call the 3rd dimension in shoe fit. This blog will explain this concept and why extra width and shape are critical to any large foot, and especially those with swelling and/or deformities.
My previous blog "Edema: causes, symptoms, and treatment” explained edema or fluid retention and how it affects feet. It gives a good basis to understand what is edema, what causes it, how it affects the legs and feet, and how to deal with it. Bottom line, edema causes swelling and can often swell the feet significantly.
When feet swell the entire foot can enlarge. I have seen cases in practice of toes that look like sausages from the swelling. The main area of swelling/edema is usually the top of the foot first then the width is next followed by the toes. Thus, fitting shoes becomes an issue. What used to fit before the edema no longer fits and can become impossible to wear. The foot now requires a wider and deeper shoe with a rounder toe box.
Dimensions of shoe sizing
Shoe sizing generally only includes 2 of the 4 "dimensions”. It includes length and width. Some shoe companies still cling to 1 width (medium) fits all. Over the past few years more companies have finally realized medium width doesn't fit most people, as our bodies have gotten bigger and so have our feet, including width. I have seen this in my 32 years of practice as most of my patients now require at least a wide shoe (some need extra wide or more). Very few companies go beyond wide to extra wide or extra extra wide(6E). Despite this, most companies don't do well beyond these two dimensions.
3rd Dimension: Shape
A shoe is manufactured on a mold of a foot called the "last”. The last comes in all the sizes the shoe will be made in, including length and width numbers. The last is the shape of the shoe. Unfortunately, most lasts just go with the same basic shape as they widen and lengthen the shoe. In many cases as the foot widens at the arch and ball of the foot where the width is measured, there is also an enlargement of the forefoot and toes that requires a larger toe box. Thus, in many cases a wide shoe or even extra wide shoe may not fit well as the toe box is set to fit a narrower foot. In effect the shoe needs a rounder wider toe box, which is the shape dimension.
The same size 10 wide mens shoe found in many companies never fit comfortably for me. When I switched to Orthofeet shoes I suddenly felt like I had new feet. WHY? The shape. The Orthofeet shoes had a much rounder boxier front or toe box. When I lined up several pair of other brand shoes with the Orthofeet shoes I could clearly see the big difference in the shape. Most other shoes had a narrower pointier toe box. They all felt too tight. My patients are often amazed to see the difference in toe box shape from many shoes to the Orthofeet shoes I wear. They never thought about the shape when purchasing shoes.
4th Dimension: Depth
There is another aspect to shoe design and fit, and that is depth. I have many patients with toe deformities who come in with pain from toes rubbing up against the top of the toe box of their shoes. When I look at the height of the toe box of many shoes, it is quite low. Again, the patients are amazed to see how much higher the toe box is on my Orthofeet shoes. My current pair measures 1 and 3/4 inches high at the toe box. That gives plenty of room for my toes to move and not rub. Many shoes I see in the office measure less than an inch high. There is barely room for the toes.
Orthofeet makes what is known as extra depth shoes. The extra depth is the entire shoe. The heel is deeper, the center of the foot and arch is deeper and of course the toe box is wider and higher. This accommodates larger thicker feet and edema. Also, it is perfect for orthotic insoles giving them room and better stability. Roomier shoes tend to be more comfortable.
Problems with Swollen Feet
Now that shoe sizing, shape and depth has been covered, swollen feet/edema can be discussed. As the feet swell, the normal size a person wears will feel too tight. But aside from feeling too tight, other complications can arise.
- • The skin will be irritated potentially causing blisters that can become infected. Infections in feet with edema are dangerous and potentially limb threatening. Swollen feet don't heal well or quickly. Chronic ulcers or sores can develop.
- • Deformities such as bunions and bunionettes (little toe side bunion) rub in the shoe even more with swelling. Hammertoes or other toe deformities also swell and rub in the toe box of many shoes causing blisters, ulcers/sores, painful corns, and jamming of the toes causing pain.
- •Swollen feet tend to bulge out the sides of the normal shoe. The foot is wider so that the regular size can't contain the foot and the foot pushes out over the sole becoming unstable. This can lead to falls and injuries.
- •Another potential issue with swollen feet in poorly fitting shoes is nerve injury. The tight shoe compresses the very superficial nerves on the top of the foot causing pain and/or numbness. At the ball of the foot between the metatarsals, the nerves going to the toes can be compressed causing nerve pain, numbness, and neuromas. These are thickened nerve coatings which compress the nerves causing symptoms such as numb toes and pain.
Shoes for swollen feet
What to look for in shoes for swollen feet?
- Length: Measure and fit shoes when feet are most swollen, which is later in day. Start with proper length which is a thumbs width longer then longest toe on largest foot when standing. If the two feet are different, go with the larger foot. Also make sure you are wearing the socks you usually wear, since thicker or thinner socks alter the space in the shoe and make the fit tighter or looser.
- Width & Depth: When fitting the shoe, again to the larger foot, make sure the foot isn’t bulging at the ball of the foot. If the ball on either side bulges out over the outsole, it is too narrow. The shoe should be comfortable and not feel like it is jammed into the shoe squeezing it. Many people think the heel has to be tight and worry that if it slips up/down a bit when walking it is too wide. Generally, shoes that fit the wide ball of the foot may be loose at the heel. That is not a major issue as slightly loose heels are ok. The heel doesn't have to feel welded into the shoe. Fit the rest of the foot and don't worry as much about the heel. Orthofeet manufactures not only wide shoes, but also extra wide shoes for swollen feet and even extra extra wide in some models (6E mens). These shoes include a wider and deeper toe box and extra depth.
- Shape: As written about above, the round shape of the toe box in Orthofeet shoes is superior for swollen feet and of course for almost anyone looking for comfort. Learn more about Orthofeet wide shoes with extra depth here.
- Upper Material: Another feature to be looking for in severe cases of swollen or very wide thick feet is shoes with stretchable material. Orthofeet manufactures these and I have used them in practice. In many cases these were the only shoes that would fit the patient. The 3D knit material stretches and conforms to the contours of your feet and don't rub. They are particularly useful with deformed toes and other bony protrusions on the feet. To view stretch shoes for swollen or wide feet click here.
- Adjustability: Specialty shoes enable you to customize and adjust the fit to your particular foot shape. Straps or laces allow you to tighten or loosen the grip in several areas to create a pressure free fit. A forefoot strap can accommodate bunions, hammertoes and swollen feet. A heel strap accommodates a wider foot/heel and laces or a strap across the instep can accommodate swollen, thick, or high instep feet.
Remember, as you age your foot changes. Even without edema most feet stretch out over the years becoming longer and wider. Then of course there are the deformities that can occur with age and disease that change the shape of the feet. What fit once when younger, no longer fits. I have seen patients gain 1 to 2 whole sizes over the years in length and width. Every year you should check the size and fit of your shoes. If you have swelling, then that should be accommodated immediately. Most people require at least wide shoes as they age and many needs extra wide if there are issues. Don't just go by number, test the shoes for fit and comfort. Shoes should be comfortable. Your feet and health depend on it.