If The Shoe Fits

Written By Kathleen Bower

Hello and welcome back to The Dance Docs! 

During an early episode Dr. Davenport and I mentioned how much we love talking about shoes, and many people responded that they wanted to know more. So on this week's episode Dr. Davenport and I sat down to discuss all things shoes and answer a few listener questions. We cover a wide range from sneakers to dance shoes, running shoes to CAM Boots and everything in between.  I hope that you get a lot out of this conversation on all things shoes.

There is no perfect shoe for everyone, and no cookie cutter approach. We make recommendations based on the current research and clinical knowledge. Just like a good pair of dance shoes it is worth the time to go see someone to be fit for the proper pair of sneakers, and can take time to find the right fit. 

Outside of dance footwear

Make it stand out

  • Anatomy of a shoe

    • Stack height

      • How high the sole of the shoe is

      • Is it minimal like a barefoot shoe (five fingers, or barefoot shoe)

      • Is it high like a hoka/ cushioned running shoe

      • The larger the stack height the more ankle stability necessary

        • Think of it almost like walking on a thick foam mat all day

        • Less contact with the ground- need more proprioceptive awareness

      • A shoe with a cushioned shoe with high stack height may be beneficial if you are going to be standing all day, but may not be the most beneficial if you are going to be walking on unstable surfaces

      • Remember that when changing shoes, it is best to make a slow transition instead of an all or nothing approach

    • Heel drop

      • Difference between the height of the heel and the height of the toe

        • High drop

          • 7mm or more

          • Asics, brooks, new balance

          • In more dynamic movement- such as running, a higher heel drop allows for more heel strike because the elevated heel helps with high impacts when the heel hits the ground

          • Usually recommend a higher heel drop for those patient who need some offloading of posterior structures, or the foot maintained in slight plantar flexion

            • Achilles tendonitis

            • Plantar fasciitis

            • Achilles tendinopathy

            • Calf strains

        • Low drop/ zero drop

          • 0-5mm

          • Hoka, altra, newton

          • Will promote more forefoot and midfoot strike

          • Leads to more ankle DF, and work through the lower leg

          • Closer to how a dancer is trained to move

          • This is what I usually recommend for individuals

            • Knee pain

            • ITB

            • Gluteal/ hamstring tendinopathies

            • Forefoot or metatarsal pain

    • Toe box

      • Is it pointy or is it wide

      • Dance usually trends towards narrow, tapered toe boxes

      • Does it look like a normal foot should fit in there with some space to move around

      • In many shoes the toe box is based on aesthetics instead of feet

      • Can the metatarsals splay and the toes sit in a lengthened position

  • Narrow vs wide vs functional/anatomical

    • Wide shoe makes the shoe wider through the midfoot

    • Functional or anatomical shoes makes the toe box wider and gives more space for the ball of the foot

  • Want to find support for the foot without over controlling the motion

  • Dancer feet

    • Modern dancers who are dancing barefoot usually have good control and stability through feet

    • Important for ballet dancers to continue working in a soft ballet slipper and not just in pointe shoes as they become more advanced

    • Ballet training progresses from slippers and articulating through feet to help the dancer build strength and control necessary for pointe work.  You don’t want to abandon it once you go en pointe

  • Ballet shoes

    • Want to make sure that the ballet slippers fit properly

    • Male dancers have a tendency to wear shoes very tight

      • Consider wearing a shoe that is slightly larger, or in socks

      • Wear a smaller shoe that is more shaped to your foot for performances only

    • Pump Bump

      • Caused by pressure on the heel from tight draw strings

      • Can be female dancers in tight pointe shoes, or male dancers in tight ballet slippers

  • Apolla Socks

    • Great for support of the foot without overly constricting the ball of the foot

    • Have recommended for dancers with heel pain, big toe pain, or bunion pain 

Shoe recommendations for when you are injured

  • Flexible vs stiff shoes

    • natural/Barefoot 

      • Footware providing minimal interface with the natural movement of the foot due to it’s high flexibility, low heel toe drop, weight and stack height, and the absence of motion control and stability devices

      • Someone who needs to build strength in the foot

      • May be appropriate for a ballroom dancer, or ballet, modern jazz dancer during the off season

    • Clog

      • Stiff sole shoe, are designed to allow for proper gait mechanics without having to actually roll through or use the foot

      • May be appropriate for someone with stress fractures as a transition between boot and a flexible shoe

    • Tennis shoe/ running/ sneaker

      • Lives kinda in the middle, can take on aspects of a natural or barefoot shoe with increased cushioning, may provide a lot of stability

  • Rocker bottom?

    • Have a thicker than normal sole with a rounded heel and toe

    • Pros: can off load rolling through the foot, and decrease work from the toes

      • May help hallux rigidus, plantar fasciitis, etc. 

        • Hallux rigidus/hallux limitus

          • Bony block vs functional

      • Can help transition midfoot issues (stress fractures)

        • Still need to strengthen foot to restore the mechanics

      • Often have lots of cushion and shock absorption 

        • Higher stack height

    • Many shoes are modified rocker these days

      • Hoka shoes are designed with a Meta-Rocker, which is built into the mid- and outsoles, near the metatarsal bones in your feet. We break the Meta-Rocker into two categories: early-stage and late-stage. 

      • Early-stage Meta-Rocker, the transition zone is placed behind the metatarsal heads. This helps create a smoother ride and a faster transition to the forefoot. 

      • Late-stage Meta-Rocker have the transition zone placed in front of the metatarsal heads, which provides a more stable base of forefoot support.

        • Clifton/ most of their shoes- Early stage Meta-Rocker 

        • Gaviota, all hiking models- late stage meta-rocker

    • Cons: can feel unstable

      • May not be the best choice for instability (ankle sprains, etc.)

      • If lived in these shoes 24/7 could weaken the feet 

      • good for recovery, not great for wearing all the time forever

      • Not a long term solution- can lead to less ROM at great toe

  • Recovery shoe

    • May need to give your feet a rest in a high cushioned shoe

    • Not the shoes that you want to wear all of the time

    • Want to make sure that the shoes are still offering some mobility through the foot and not allowing it to fully shut down

To insole or not to insole

  • There is a place for them

    • I always ask what is the end game for the insole? 

    • For the majority of people it is not the long term solution. Focusing on strengthening the foot and ankle should be part of the plan.  Also need to make sure to address any strength deficiencies farther up the chain in the hip, knee and back

    • We don’t tell you to wear a back brace forever, so why are we doing this to the feet

    • If your feet had a 6 pack we would all care about them

  • We never say never in medicine, but I almost never recommend these without PT and strengthening

  • Pros: Can use for acute injuries to offload an injury, and they can support the arch

  • Cons: can weaken feet

  • Must wean into these (start 1 hour, and increase gradually)

  • Don’t just want to put an orthotic in your shoe, your shoe may already have the necessary support

  • Have to look at the whole system

Understanding built in shoe support

  • First things I do when i am assessing someone for sneakers or running shoes

    • Want to look at their heel position in normal resting stance

      • pronation/ neutral/ supination

    • What is their hindfoot mobility like

      • Full body rotation- can the hindfoot pronate and supinate?

    • Look at the bottom of previous shoes

      • What is the wear pattern like?

        • Is it medial- may have someone who over pronates

        • Do they have wear over the lateral heel and big toe- pretty normal and strong foot

          • Is it lateral- do they have a history of lateral ankle sprains and instability of the chain?

  • Pronation/Stability

    • Pronation is a rolling in of the foot- Look at this from behind and what the calcaneus (heel bone is doing)

    • Everyone's foot needs to pronate, don’t be scared of the pronation

    • Someone with a true hindfoot pronation and lack of muscular support may be a good candidate for a pronation support shoes

    • This does not mean that there is more arch support!

    • The shoe contains a more dense foam on the medial side (inside of the shoes) that acts as a post for the calcaneus driving it into a more neutral position

    • If you are walking this might be ok, but i have seen many runners and dancers in the clinic that end of up with knee pain from their shoes being over supporting and overloading the medial side of the leg

  • Neutral

    • Has the same density foam throughout the sole of the shoe

    • Where I start most people

  • Supination

    • Has increased cushioning on the lateral side of the shoe to cushion a more rigid foot

    • Recommend for someone with a true rigid foot or a hindfoot that is in a supinated position

Medical footwear

  • Medical Shoe

  • Short boot

  • CAM boot (full boot)

  • What kind of shoe should I wear if I am in a Boot (CAM boot- controlled ankle motion)

    • Want to find a shoe with a stack high of ~25-30mm

    • CAM boot is designed as a rocker bottom

    • Great options are 

      • many of the HOKA models- usually recommend the clifton

      • Altra Paradigm, Provision, Torrin

    • If you don’t want to purchase shoes, you can find a specific shoe lift called the Leveler or Even-Up that is adjustable and slips right over current shoes that you own 

Dance footwear

  • Most important thing is to give yourself time to adjust to your shoes

  • Pointe shoes

    • Consider being fit for new pointe shoes

      • every year while you are growing

      • Every 2 years for baseline

      • After every injury

    • Your feet should adapt to the changes that you are asking of it

    • We were seeing many changes happen due to COVID, and lack of wearing shoes.  Don’t just try to jam your shoes back on

  • Listener question- Dancer who wants to wear pointe shoes at home… yea or ney 

    • The reason a lot of people say no is because they are unsure if you know how to break in your shoes

      • Instructors may want you to work through your feet and shoes in a specific way

      • An older dancer may be ok to wear at home

    • I will allow my dancers to start walking around their home in pointe shoes to start breaking them in, but rarely to do en pointe

    • Depends on if you have a home studio with an appropriate floor surface, and do you know how to work your feet.

    • If you are going to go against the advice, make sure that you are being safe and not trying things that you are not ready for. 

Thank you for visiting our show notes. If you have any questions please feel free to contact us!

In Health,

Dr. Kat Bower PT, DPT

Kathleen Bower
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