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The best and worst shoes for back pain

Do you have back pain? How to choose shoes that don’t hurt and could help.

Back pain can have many causes. Maybe you overworked yourself. You may be sedentary most hours of the day. Or maybe you have an underlying condition that’s causing back pain. If you have had back pain for more than a month, if your pain is getting worse over time, or if you have new neurological symptoms such as numbness or weakness in any part of your body, it is best to see a doctor.

But once you’ve discussed your symptoms with your doctor, or want to get some sensible advice first, you should consider whether your shoe choice might be contributing to your back pain.

What works best for one person may not necessarily work the same way for others. For example, in some people, large differences in limb length can cause problems that are exacerbated by wearing the wrong shoes.

But for many people, finding shoes that fit well, have adequate cushioning, and offer the right kind of support is a step in the right direction.

What to look for when choosing shoes

Shoes, sneakers, and other footwear should be comfortable and not pinch or irritate the foot, even if they are new. When trying on shoes, take the time to walk in them and notice how they feel. No matter what they look like, don’t buy shoes that are too tight, too loose, unsupportive, or uncomfortable in any way.

To increase your chances of finding a comfortable shoe, here are some features to look for:

Moderate heel height

Shoes with a slight heel are best. The fact that your heels are slightly elevated allows your ankle to rotate a little and pivot differently.

Conversely, a heel that is the same height or lower than the toe of the shoe will affect the way your leg rotates and, in turn, your pelvis. This affects your spine and lower back, causing back pain. A heel of less than 5 cm is preferred, never higher.

While heel height is more often an issue in women’s shoes, the positive concept of heel height applies to men as well. However, most men’s shoes have a neutral heel height, so the heel and toe are level… and men are less likely to experience back pain than women.

cushioning and shock absorption

In addition to heel height, how the heel of the shoe absorbs shock is important to how your back feels. Some people hit the ground harder with their heels than others when walking, which sends a shock down their legs and back.

The problem can be exacerbated in people who wear dress shoes, a cork heel can help. The same applies to a rubber heel or wedge shoes. The sweet spot is in the middle: a shoe that is neither too hard nor too soft.

When it comes to running shoes, “maximum” shoes with a lot of cushioning are very popular with ultramarathon runners and people with tall feet.
According to a January 2020 article in Podiatry Today, opting for a cushioned shoe can allow runners to absorb more shock and can therefore be a good option for older runners, runners with a history of stress injuries, or runners who primarily run on hard surfaces walk like cobblestones.

rocker soles

Rocker soles aren’t for everyone, but they can come in handy in some situations. These are thick soles that are arched at the front and sometimes the back of the shoe, allowing the foot to move normally with less pressure on the joints and sole of the foot in general.

Rocker soles are a common feature of therapeutic shoes prescribed to people with diabetes-related foot problems, and they have also become more common on some types of sneakers and hiking shoes marketed to the general public.

Sneakers with a thick rubber sole cushion the impact on the heel. They can be helpful in treating plantar fasciitis, as well as knee, hip, and back pain.

Sandals with arch support

In general, sandals and flip flops don’t offer much support. But special orthopedic-style sandals are an exception. They provide adequate arch support.

Shoes to avoid if you suffer from back pain

The longer you wear a pair of shoes and the longer you want to stand or walk in them, the more important it is that they offer good support exactly where you need it.

Here are some red flags when it comes to shoes:

Beware of negative stubs

Non-orthopedic flip-flops, while not good for your feet, are fine for a quick stroll around the neighborhood or to the beach, but they’re not recommended for all-day wear, especially if you’re already suffering from headaches.

Most flip flops actually drop your heel under your toes, creating a negative heel. While she notes that they offer some cushioning, this is a “false sense of cushioning” since the sole of a flip-flop isn’t typically thick enough to absorb the shock of each step.

Slippers have the same problems as flip flops, but of course not many people wear slippers when going out. So as long as you only wear slippers at home, you don’t have to worry about it too much.

In general, beware of “anything with a negative stub”. These include flat moccasins and ballerinas with very flat soles. These types of shoes cause the pelvis to rotate, which can make back pain worse.

A problem that is too hard or too soft

Remember that you want your shoes to absorb shock and it’s best to avoid “super hard” shoes. Typical dress shoes fall into this category due to their lack of cushioning.

Shoes with memory foam or air cushions can be more of a problem as they don’t provide the right amount of support alongside cushioning. However, these types of cushioning combined with a supportive heel aren’t all that bad.

Minimalist shoes are generally not recommended

Minimalist shoes, sometimes called “barefoot shoes” because of their very thin soles, are not good for your back. People who already have back problems usually find that these types of shoes do nothing to alleviate those problems and can cause back pain.

These shoes also turn the pelvis differently than shoes with thicker soles. For what it’s worth when it comes to wearing minimalist shoes, it’s up to you to decide what’s comfortable for you.

Casual sneakers may lack support

Casual sneakers like the classic Converse Chuck Taylor All-Stars are problematic because they’re flat, narrow, and lack support.

Where to find help choosing your shoes

If you need more customized shoe recommendations, consult a podiatrist who is trained in biomechanics and can identify issues such as gait abnormalities. Some shoe stores have trained staff who can provide shoe recommendations based on foot shape and measurements.

Remember that if you still have back pain despite wearing the right shoes, it may be time to look for other causes of your pain. Your GP is a good place to start looking for signs of medical issues that could be causing your back pain, as well as to consider aspects of your lifestyle that may be contributing and changes you can make.

* Presse Santé strives to convey health knowledge in a language accessible to all. In NO CASE can the information given replace the advice of a doctor.

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