Chris L. Wells, PhD, PT, CCS, ATC
Exercise has been described as essential for transplant recipients. Walking is an easy way to get exercise, and investing in good shoes may be all you need to get started. The shoes you wear can have a great impact upon your risk of injuries and the energy you expend standing, walking, or running. Good shoes can also offer protection for recipients who are experiencing gout, diabetes, thin skin or fatigue.
How many people think about the purpose or construction of a shoe while shopping? Unfortunately, the color, brand name and look typically drive your purchase more than it should.
The ideal shoes should distribute your weight when your foot hits the ground, up through your joints (ankle, knee, and spine) to achieve optimal comfort. The wrong pair of shoes can cause a wide variety of problems: calluses, bunions, nerve and joint pain from the foot all the way up to the low back.
Test the shoes you are wearing now! First examine the length of the shoe; there should be at least ½ and ¾ inch between your longest toe and the front of the shoe for adults and children, respectively. Next, place a piece of paper under your shoeless foot and distribute your weight equally between both feet while you have a friend trace one foot and then the other onto the paper. Now place your shoes on top of the tracing. The shoe should cover all of the tracing; if it does not the shoes do not properly feet your feet and it is time to go shopping.
Examine the "Last" First!
The first part of the shoe you should examine is "the last". The last is the solid form from which the shoe is molded. Turn the shoe over and draw a line through the heel—so it is divided into two equal parts along the length of the shoe. Then divide the front of the shoe at the widest part into two equal parts along the length of the shoe. Now look at the angle created by the two lines. Typically you want to select a shoe that has the straightest lines or as close to 180 degrees. The "last" of the shoe should match the outline of your foot. You can learn more at http://www.shoeschool.com/shoeschool/lasts/shoe_lasts_what.html
There are several things to consider about the sole of the shoe. When you transfer the weight of your body onto the ball of your foot, the shoe should bend at the same place your foot bends, at the ball of your foot. Depending on the speed, the hardness of the surface, or if you are going down stairs or up inclines, the more force your body has to absorb. With walking, typically your legs and back need to absorb at least twice your body weight. This force can exceed five times your weight during activities such as jogging. Therefore, the material used to make the sole is important. The harder and less flexible the sole the more force your legs and back will need to absorb. In general, older people and people who are jogging for fitness, playing sports or working on concrete floors should select a softer, rubber sole.
Consider the width and height of the heel. The lower and wider the heel the more stability the shoe will provide. A high heel causes more of a bend in the knees and hips and creates an arch in the low back.
Next, examine the top of the shoe; look at the toe box (area of shoe where the toe is) and the vamp (material over the in-step). There should be enough depth in the front of the shoe to allow you to freely wiggle your toes up and down and spread your toes apart. The foot and toes should not be compressed by any part of the shoe as it can lead to an increased risk of developing bunions, stretching out the ligaments that support the joints and compressing the nerves, leading to severe pain. For some occupations and diseases affecting the feet, you may want to purchase shoes that have a rigid toe box to protect your toes.
Selecting shoes with laces allows you to make some adjustment across the top or throat of the shoe. The top of the shoe should not be tight across the arch of the foot. To improve the fit of the shoe you can use two short laces. This will allow you to adjust how tight the lower part of the shoe is tied in comparison to how tight the upper shoe lace is tied. If you have difficulty reaching your feet or have difficulty tying your laces you can use elastic laces that do not need to be tied.
The Ankle and Heel
The shoe should not rub against the bones of your ankle and the heel should be snug to prevent your foot from sliding up and down in the shoe. Avoid shoes with straps, high heels, and open toes if you have impaired circulation or skin problems. After purchasing a new pair of shoes, gradually break them in; it is suggested to wear the new shoes for two hours a day and gradually increase wearing time by two hours per week to assure you do not develop unnecessary problems and pain.
There are new models of shoes that claim to reduce injuries and make you walk better, jump higher and decrease pain. One of the newest shoes on the market today is "Z-Coil shoes". These shoes have a rocker sole or rounded sole that aids in moving your body weight from the heel to the toes more effective. This feature is very commonly used in braces and specially made shoes. Another feature of the shoe is a coil under the heel that reduces the force when your foot strikes the ground. At present, I found no independent research that supports the manufacturer's claims. There are many positive testimonies from happy consumers and some reports of injuries when the person lost their balance and fell off the high coil. Always ask the sales person to show you independent research on the effectiveness of their product.
My personal suggestions are for you to work with a health care professional (athletic trainer, orthotist—a person who designs and fits artificial devices and shoes for people with disabilities—physical therapist, or podiatrist) in selecting the right shoes if you have significant problems extending from your feet to your low back.
You can also consult a health care professional to be evaluated for individualized inserts or orthotics to improve the health of your feet, legs and back as well as improve your activity tolerance. Make sure you interview the professional in regards to how frequently they make orthotics and how often adjustments are needed to the inserts. In addition, ask for references from previous patients. This is important because, unless you have diabetes, typically insurance will not pay for orthotics.