The Best and Worst Shoes for Back Pain

Back pain can start at your feet — specifically with the shoes you’re wearing. Find out about the link between back pain and footwear.

The Best and Worst Shoes for Back Pain
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Your flip flop or stiletto habit could be the cause of your back pain.

Few of us are strangers to lower back pain. In fact, more than 50 percent of working Americans suffer from it each year, according to the American Chiropractic Association. Not only that, but back pain ranks as the number two reason people see a doctor.

Sometimes the cause is obvious, like a sports injury or bending the wrong way. Other times, however, the reason might be surprising, like when the culprit turns out to be your feet and improper footwear. But finding the right shoes — and there are many choices — can be all the back pain treatment you need.

Back Pain and Footwear: What’s the Connection?

Though your feet and favorite stilettos can seem far removed from your back, they really can be related and contributing to your pain and, in turn, stress and fatigue. “Feet are like the foundation of a building,” says David S. Wolf, DPM, a podiatrist and professor of nursing at the University of Texas Health Science Center at Houston.

“If the feet are mechanically unsound, they can change the alignment of all the structures above them. I often see patients with a mechanically ‘unsound’ foot who are experiencing pain. Wearing shoes that don’t give the proper support can exacerbate the problem.”

Back pain and footwear can also be connected through poor choices made as consumers and fashionistas. For example, those high heels can throw off alignment and add extra stress and strain on the lower back. Flip flops, at the other extreme, are so flat that the lack of support can lead to arch pain, heel pain, ankle pain, or knee pain, says Dr. Wolf. Even comfy Crocs lack arch and ankle support and may cause problems.

 When Is It Time to Visit the Podiatrist?

Back pain can have many causes, but if your primary doctor can’t determine the reason for your pain, then it’s time to consider seeing a podiatrist to check out your feet, gait, and alignment. To prepare for the appointment, make a list of questions and symptoms along with a medical history, including medications taken and lab tests and other tests you’ve had, such as X-rays and MRIs. Also, if your pain gets worse when you exercise or walk, be sure to bring along the shoes you wear for those activities.

The Pros and Cons of Specialized Footwear

Besides avoiding certain types of shoes like high heels and flip flops, consider proactively purchasing special shoes that can help prevent or ease your back pain. “Specialized footwear means footwear that has been modified to treat your particular foot condition, most often with inserts or orthotics,” says Sonu S. Ahluwalia, MD, clinical chief of orthopedic surgery at Cedars Sinai Medical Center in Los Angeles.

By wearing specialized footwear, you may see improvement in foot and overall alignment, which can lead to more efficient muscle use. You can also get shoes custom made to address your specific foot and back issues.

Getting specialized footwear isn’t quite as easy as going to your favorite shoe store. You need to be fitted by a specialist, and the shoes can be costly. As with any shoes, prices vary by brand, but specialized footwear generally costs from $150 to $200. (Note, though, that your podiatrist may have a coupon you can use at specialized shoe stores.) Also, because your feet will probably change over time, you may need to have the shoes modified in the future.

Best Footwear for Back Pain

You have a number of good choices for shoes designed to ease or reduce symptoms from musculoskeletal complaints involving foot, knee, hip, and back pain, says Kenneth S. Jung, MD, a foot and ankle surgeon at Kerlan-Jobe Orthopaedic Clinic in Los Angeles. “All of these are linked, and the force imparted on the foot is ultimately imparted on the back.”

You’ll be able to find some shoe choices at regular stores, and you’ll need to go to a specialty shop for the more customized ones. The most important thing is to make sure you choose the right shoe for your particular foot type and problem.

One of the most important features to look for is the arch — it should be designed to work with the natural arch of your feet. Generally speaking there are three shapes of foot arch: pronation (low), neutral, and supination (high).

Running shoes are generally designed to address many different issues, with motion control helping pronation, stability for the neutral arch, and cushioned to assist supination arches. Dr. Ahluwalia recommends New Balance 1140, New Balance 1340, and New Balance 1540. He also suggests Brooks Beast anti-pronation shoes for people who are pronators.

“Minimal” shoes are a specialized option to consider. “These shoes are designed to promote the foot striking the ground with the front or middle of the foot rather than the heel,” says Dr. Jung. “This alters the way the foot and the lower extremity contact and interact with the ground.”

Specially designed inserts or insoles can also provide back pain treatment in some cases because they provide extra support.

Prescription orthotics are another kind of specialized shoe. So-called functional orthotics are usually made from plastic or graphite and can treat issues caused by abnormal motion. Another type, called accommodative orthotics, are softer and used more for the support and cushioning needed in painful foot conditions rather than back pain.

Ultimately, the first step to take is a podiatrist visit — with the right diagnosis and recommendations for footwear, it could be the last step you take in pain.

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