Athletic Shoe Guidelines

I cannot tell you how many times I get asked about shoe recommendations. And that’s not just because of what I am wearing, which are usually bright Asics. I also wear crocs, especially at home.  Patients of all shapes and sizes with all different backgrounds with all different jobs ask me the same question – doc, what shoes do you recommend?

Every patient has unique shoe fitting requirements. Most people know that their own two feet are not exactly alike. One foot is almost always a lit bit bigger than the other. Also, it’s a myth that your foot size doesn’t change once you’re an adult. It does change, specifically as we go into geriatric years. Make sure to measure your foot each time you try on new shoes. As you may also know, not all shoe manufacturers use the same sizing system. For instance, I wear a 13 in Asics but a 14 in Adidas. Sizes vary by band so make sure you pick the shoe that fits, not the shoe that’s your size.

Athletic footwear should be fitted to hold the foot in the position that’s most natural to the movement involved. Athletic shoes protect your feet from the stresses encountered in a given sport and to give the individual more traction. The differences in design and variations in material, weight, lacing characteristics, and other factors among athletic shoes are meant to protect the areas of the feet that encounter the most stress. Well-fitted athletic shoes need to be comfortable, yet well-constructed and appropriate for a given activity. A good fit will mitigate blisters and other skin irritations. Sports-specific athletic shoes are a good investment for serious athletes, though perhaps a less critical consideration for non-athletes.

Athletic shoes need to be replaced after one year, whether or not they are worn, and after a certain amount of repetitive load is placed on them and wears them down. The American Academy of Podiatric Sports Medicine advises replacing running or walking shoes after 300 to 500 miles of wear, and replacing aerobic, basketball, and tennis shoes after 45 to 60 hours of wear. Athletic shoes should also be replaced if they show signs of unevenness when placed on a flat surface, display noticeable creasing, and/or when the heel counter breaks down.


Today’s athletic shoe companies offer a dizzying array of styles of running shoes in multiple categories such as motion control, stability, cushioned trainers, and racing flats. It is almost impossible to stay abreast of all the current styles and technologies. Even if you study and become current with all of these shoes, the companies constantly change styles and introduce new models. Running magazines such as Runners World and Running Times regularly publish shoe evaluations and rate shoes in all categories. These surveys offer updates on new models and technologies, but do not always provide a comprehensive look at the best shoes available.

In addition, it is increasingly more difficult to find a shoe retailer with qualified employees who takes the time to fit their customers. As a response to this market niche, there are independently owned specialty running stores cropping up all over the metroplex that take pride in providing expert advice and fitting of footwear. They often employee experienced runners who enjoy running and their work as well. Oftentimes, premium athletic shoe companies will send their technical sales representatives to these stores to educate and train them about their products. So the employees are constantly updated in new technologies. The American Academy of Podiatric Sports Medicine (AAPSM) does not recommend or endorse any specific shoe companies. To date, there has not been a reliable, repeatable methodology of footwear assessment that meets the standards of evidence based medicine. Athletic shoe fitting is a process that must be done one-on-one with an experienced shoe fitter. Footwear’s effects on comfort and performance cannot be reliable predicted for the masses. The ultimate test of any shoe is the individual experience the user has with it.

Any quality athletic shoe store will require a correct foot measurement using a Brannock device before even trying on a shoe. They should ask about running history, injuries, and evaluate your gait. Only then can they make a well informed shoe recommendation based on your specific foot and your particular athletic shoe needs.


I usually tell patients to look for four things when they are trying on shoes. One, make sure you are trying on shoes at the end of the day. Why? Because your feet tend to swell towards the end of the day, after being on them constantly, and having gravity pull the excess fluid in your body towards the ground. Voila! Swollen feet. Two, make sure the shoe passes the “pinkie test.” That means put your pinkie on the bottom of the shoe towards the front where your toes bend. Push up. Your shoe should not fold and bend, like a taco. It should be firm and supportive. It’s OK to bend a little but it should not be completely flexible, like a flip flop. Three, press down on the back of the heel. It should not press into the sole of the shoe where your foot goes. This should be as rigid as possible to provide support. Four, once your shoes are on, you should be able to put a thumb between the end of the longest toe (big or second) and the tip of the shoe while you are standing. If you thumb hangs off, the shoe is too small. If you cannot touch the tip of your toe, the shoe is too big.

Several clues can be gleaned from looking at your current shoes. If possible, remove the insole of your current shoe. Look at the toe wear pattern is.  Is it right at the edge or is there sufficient space to allow room for your toes to move. Next, look at the back of your shoe while it is sitting on a flat surface. Does it cock or lean to one side? Also, look at the bottom of your current shoe. If your shoe is worn away on the outside with little to no wear on the inside, you are a supinator. This directly corresponds to high arches, or pes cavus and translates into the fact that you likely have weak ankles, hammer toes later in life, and heel pain. Congratulations! You may also be an avid runner. Underpronation causes wear on the outer edge of the heel and the little toe. Look for a cushioned shoe with a soft midsole. If the opposite is true, you wear away most of the inside of your sole and have little wear outwards, you are a pronator. That means you have pes planus, or flat feet, and you roll your feet towards the center of your body. You more than likely will develop bunions and will have moderate to significant foot pain and/or fatigue. Again, congratulations are in order. Overpronation can create extra wear on the outside heel and inside forefoot. You’ll want a shoe with a motion-control feature and maximum support. Hopefully you have “normal feet” and don’t have irregular wear patterns. You have a neutral arch if your shoes wear out uniformly. Look for a “stability” shoe, which has the right mix of cushioning and support.

Also, don’t buy multi-task shoes. In other words, walking shoes are stiffer and running shoes are more flexible and lighter. Don’t use the same shoes for both activities. A running shoe is built to take impact, while a tennis shoe provides more support, permitting sudden stops and turns. Cross training shoes are a general athletic shoe, such as for physical education classes or health club exercising, including using stair machines and weight-lifting because they provide more lateral support and less flexibility than running shoes. They also tend to be heavier than running shoes, but most people don’t need light, flexible shoes for cross-training. And remember if a child is involved more heavily in any single sport, he or she should wear shoes specifically designed for that sport.

My preferred brand for everyday activities, not specifically or always for running, are Asics, which is an acronym for the Latin phrase anima sana in corpore sano which translates as “a healthy mind in a healthy body”. New Balance makes the largest selection of wide shoes. Shoes specifically for running should be based on your personal preference and choice. I don’t recommend switching brands once you find a particular shoe you like best, like Brooks, Mizuno, or Saucony. It’s better to stay in-brand than venture out to different ones once you become accustomed to a certain shoe.

A word about deformities or special conditions is needed here. Obviously, people with bunion and hammer toe problems needs shoe that can accommodate their deformity. Buying a shoe that looks cool but doesn’t have room for your tailor’s bunion is no bueno. Diabetic patients also require specific shoes with custom molded inserts. I would never recommend an off-the-counter, store bought shoe for a diabetic. That’s like recommending all weather tires for someone who lives in the Alaskan wilderness.