A Therapist’s Guide to Proper Shoe Selection

 “What’s a good shoe?”  As physical therapists treating patients returning to exercise following injury or currently dealing with foot and leg pain, this is a question we hear quite often.  Since I spent time working in a running-specialty shoe store, this is a question I’ve heard a lot over the years and will still frequently be asked by friends and family.  Many people will select shoes by the color they like, the clearance price they found, or the one their friend on Facebook suggested. No matter your planned use, there is a bit more to finding a shoe that will be good to your body, and I’d like to share some simple tips for selection.

  1. Don’t get too hung up on your foot type.

For the better part of the last 20 years, it has generally been passed around that certain foot types belong in a specific type of shoe.  For example, someone with a high arch (increased space between your mid-foot and floor) should be in a neutral or cushioned shoe, whereas somewhere with a low arch (a flat foot) should be in a shoe designed to control motion, or a stability shoe.  However, there has been very little evidence produced to support this idea.1 Many shoes are advertised to slow or prevent foot pronation, but what we are now finding is that pronation is not necessarily associated with injury risk and type of footwear may not alter the biomechanics at our feet as much as we once believed. This is good to know and backed by the fact that shoe manufacturers themselves are moving away from this model and are categorizing shoes this way less and less often.

While knowing your foot type may no longer be seen as the most important component to selecting a shoe, past injury history or complaints can matter.  While these findings can not necessarily be applied to simply walking in a shoe, it is believed that footwear that is more minimal decreases the forces on the knee with running.3,4 Minimal footwear is typically less cushioned, allows for greater flexibility of the foot, and sits lower to the ground than traditional footwear.  However, if you have had or are currently having issues with areas at the ankle, such as the achilles, a more cushioned, less minimal shoe may be ideal.  Most importantly, if you’re considering switching to a shoe that is significantly different than the one you are currently wearing, be sure to give yourself time to acclimate and make a gradual transition.

  1. Put that shoe on your foot! And another one, and another one…

Recent research is finding correlations between the general comfort of a shoe and rate of injury occurrence.5  Additionally, whatever the compensatory movement you are trying to prevent, if a shoe is comfortable, it is more likely you will utilize a normal gait pattern.  However, comfort can’t be measured in an online review or with your friend’s opinion.  Just as individuals vary… feet vary!  Trying to select a shoe that is comfortable for you without trying that shoe on would be like trying to decide your favorite food without ever sampling various meals.

I would suggest trying on a minimum of 3 shoes before making your selection.  One reason for this is because if you haven’t put a “new” shoe on your foot in a while, it’s likely anything you put on will feel good.  Trying on multiple shoes will also help you to note differences in the last (the part of the shoe the wraps around the foot itself) fit, varying levels of cushioning, and how the shoe allows your foot to move.

One area where I have seen people get too caught up in is the “brand” of the shoe.  Regardless of a shoe you have had success with in the past or a friend’s recommendation, shoes can change drastically from year to year.  Different models of shoes within the same brand can vary significantly as well.  I would urge someone looking for a new shoe to try as many as possible and to remove any bias regarding a certain shoe; really examine how it feels.

  1. Make sure it fits.

This is the area that I have seen people make the most mistakes, especially when it comes to selecting a shoe they plan to exercise in or spend significant amounts of time in.  Our foot size changes as the day progresses and this is why it is typically advised you try on new shoes at the end of the day or following exercise.  Full disclosure: for a lot of people, this might mean increasing a full size from what they’ve worn previously or from what they would wear in a dress shoe.

It is typical to leave about a thumb-length (or a little less than an inch) between the end of your longest toe and the tip of the shoe.  But don’t forget width!  It might be necessary to go up in width (standard width for women’s shoes is a B, and for men’s shoes is a D) in order to create enough space for your foot.  This allows for healthy and normal movement of the foot and ensures you are not restricting blood-flow or putting excessive pressure on the nerves that innervate your foot.  For people who have foot pathology such as plantar fasciopathy, neuromas, or are experiencing numbness and tingling, this can be especially important.  One quick “test” you can perform before purchasing a shoe, is to pull out the insole of the shoe and stand with your full body weight resting on your feet. Be sure that you foot doesn’t “spill” over the insole, because if it does, this shoe will likely restrict the position of your foot in an abnormal way.

  1. Know when it’s time to replace it.

Remember just because you paid good money for it, doesn’t make it indispensable.  If you are running in your shoes, it is recommended that you replace them between 350-500 miles.  Lower impact activity won’t break your shoes down as quickly, but you still want to keep total mileage in mind. If you are using the shoes for everyday use and getting about 6,000 steps a day, that means new shoes every 5-6 months.  That’s quick!  One way you can help your shoes last a little longer is by rotating out your shoes depending on the activity you’ll be using them for.  But regardless, if you’ve had the same shoes for nearly a year, it might be worth looking into replacement.

  1. Know when you need more than a shoe.

With all of this being said, a new shoe will never be a fix all.  While shoes may contribute to symptoms or give us temporary relief of symptoms, they are simply a tool.  If you are experiencing pain, this is your body signaling something is wrong, and what current research has shown us is that a shoe alone does not cause or prevent dysfunctional movement.

Something we know for certain is that the number one risk factor for sustaining an injury is having history of a previous injury.6  Meaning, even if a new shoe offered temporary relief in symptoms, the underlying issue is likely still present and could manifest itself later in a different or even similar fashion.  Physical therapist are trained to assess how the body is moving and a good therapist can help you sniff out limitations in mobility and stability that are contributing to your symptoms, either past or present.  If you currently having pain, or have experienced symptoms in the past, a new shoe purchase may in fact be warranted, but be sure you are addressing the most important factor first: your body.

  1. Okay, but where do I go?

If you’re reading this, I’m going to bet you know where to go for a physical therapist, so let’s assume you’re now 100% healthy, and looking only for a shoe.  I would suggest seeking out a specialty running store.  Even if the shoe you’re looking for will be used for standing at work or walking, a typical specialty store will carry only higher quality levels of shoes, designed to last for the time discussed above.  Selecting a shoe can already be overwhelming, and you don’t need a pair of Air Jordan’s or Birkenstock sandals to muddy the waters.  Additionally, many brands who make great shoes, such as Nike, New Balance, and Asics, will also make a less expensive shoe designed more for casual wear.  To the average consumer, these can be difficult to filter out by looks alone but will typically not be stocked at a specialty running store.

Legends (Owensboro, KY) and Ultimate Fit (Evansville, IN) are two local establishments that fall into the “Run Specialty” category when it comes to shoe stores.  If you’re looking for a local spot, a few things to ask when you arrive to the store would be what their process is for fitting someone in shoes and if they have any type of satisfaction guarantee on the products they sell.  Many running shoe companies, such as Brooks, offer a 30-day trial period on their shoes, which the shoe store should pass along on the products they sell.  You’re going to be paying good money for your shoes, so make sure the person helping you with the product is knowledgeable regarding fit and differences between shoe options. 


  1. Richards CE, Magin PJ, Callister R Is your prescription of distance running shoes evidence-based? British Journal of Sports Medicine 2009;43:159-162.
  2. Nielsen RO, Buist I, Parner ET, et al Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study. British Journal of Sports Medicine 2014;48:440-447.
  3. Kerrigan DC, Franz JR, Keenan GS, et al. The effect of running shoes on lower extremity joint torques. PM&R 2009;12:1058-1063.
  4. Hannigan JJ, Pollard CD. Differences in running biomechanics between a maximal, traditional, and minimal running shoe. Journal of Science and Medicine in Sport
  5. Nigg B, Baltich J, Hoerzer S, et al. Running shoes and running injuries: mythbusting and a proposal for two new paradigms: ‘preferred movement path’ and ‘comfort filter’ British Journal of Sports Medicine 2015;49:1290-1294.
  6. Fulton J, Wright K, Kelly M, et al. Injury risk is altered by previous injury: a systematic review of the literature and presentation of causative neuromuscular factors. Int J Sports Phys Ther. 2014;9(5):583–595.

Course Login