Help! I need new shoes and don't know how to choose!!!

I don't approve of Cinderella's stepsister's fit in this shoe
(Credit to Disney for the photo)

You've all been there before. Your favorite pair of sneakers has begun to keep less and less of your foot covered, the sole is worn through, your toes are peeking out like your pet spaniel's tongue from the end of your shoe. However it happens, you realize it's time for a new pair of shoes. The wave of panic hits you: "where do I begin?" Well, have no fear, help is here!

Before I dive in, I think it's fair to warn you that I'm not going to give you style advice. There's no shortage of "influencers" out there to help you out with style tips. As a physician, my top priority is the health of your feet, not the health of your social life, Instagram celebrity status, or your vanity. That doesn't mean that good, healthy shoes can't be stylish. It just means that my top priority is comfort, support, and function with only the tiniest consideration clear in the back corner of my mind for style.

Support

This is a Fail

When considering what shoes to buy, there are a few things to consider. The top priorities have to be (at least from my perspective) fit, support, and comfort. If you're a reader of my blog, you're already familiar with the "Squish Test." That's the first thing I recommend someone do before ever trying a shoe on. If it fails the test, I simply place it back on the rack and try another one. The purpose of the test is to judge how much arch support your shoe provides, so you're not walking around with shoes that hurt your overall foot health and can lead to a number of other conditions, like plantar fasciitis, tendinitis, etc.

Fit

Pass!

Once a shoe passes the Squish Test, I recommend trying the shoes on for fit and comfort (shocking, I know). That goes without saying, but do you know how a properly fitted shoe should feel? How should it fit? What's too big? Too small? A properly fitted shoe is very individual, but you should generally have about 3/4 of a thumb width between your toe and the end of the shoe. That allows for enough space for the toes to not be crammed in, while avoiding having the "clown shoe" effect on you. Your toes shouldn't have a huge cavern to flop around in, but they shouldn't be crammed in. We're looking for a home-in-the-suburbs feel, not a mansion in the country or a studio apartment along Central park. 

The toes shouldn't rub on the inside of the shoe, either. If the tops of your toes are rubbing constantly on the inside of your shoe toe-box, they're too tight. You should have about 1/8" space from the top of the toes to the inner shoe surface. Tighter fits than this will lead to blisters or corns that are painful and can potentially cause sores with increased risk of infection--especially if you're diabetic or have some sort of neuropathy.

Comfort

The last consideration for choosing a shoe--from purely a functional perspective--is comfort. The shoes should have proper padding to prevent blisters, sores, etc. I also recommend evaluation to see if you can take out the stock insole so you can put in custom or semi-custom inserts. This is very important to consider, especially if you have any of the conditions I've listed previously.

Recommendations

Another disclaimer I have to make is that I don't have any interest in shoe companies. I don't own stock, have family involved, or have any conflicts of interest when making shoe recommendations. I don't care what companies think of my opinion of their shoes. I'm sure they don't care because they sell enough shoes without the need for my approval anyway. That being said, there are brands I recommend to my patients because they are easy to find, relatively affordable, and pass the above tests at a higher rate than other brands. A few general trends I've noticed (again, with the reminder that the tests I've listed are more important than brand name) is that most popular shoes don't pass the squish test, virtually no off-brand shoes pass the test, and even shoe brands known for a running pedigree have certain shoes that don't pass the tests.

Update: Special thanks to modernshoe.com for providing the shoes for the pictures below
*This article was published first without any pictures, and I'm not receiving any royalty or incentive to put these shoes on the blog. They came to introduce their products to our office a few days after the article was published (unbeknownst to them) and I asked if I could get some pics of these brands since they had ended up on my list of shoes.

Asics

These are my first line in shoe recommendations. They're readily available at most stores, I haven't yet found a pair that doesn't pass the Squish Test, and they are generally well-made and comfortable. It is possible to find good looking ones, but they don't exactly work in the formal setting. These I recommend as a good, functional, every day shoe.

New Balance

These are my next recommendation. Generally, they are as available as the Asics. They also have a few more lines in walking, comfort, and semi-dress appearance. I know patients who work in offices where black, semi-formal shoes are required that these have passed those requirements and been good options. They are available in wider width shoe options, which not all brands offer.

Adidas Running Line

Adidas is a good overall brand, but you have to be especially careful about the shoes you select passing the tests. The running line is a good option and I've personally used them with great success.

Nike

This is a brand that most of their shoes I don't often recommend. Many of the shoes are very stylish, but often lack proper support. This is a brand that the Squish Test is vital for, because it's hit-or-miss on which ones have proper arch support. Unfortunately, I see this brand as largely a fashion accessory first and a functional shoe second. The materials and appearance are solid, but support can often lag behind. So be careful. If they pass the tests, though, go for it. That being said, I've had some patients that can only tolerate (medically, not socially) wearing Nike shoes because they need a cushioned shoe, not a supportive one. Largely, they are comfortable but tend to have average-to-below-average support. If you love your Nike Air basketball shoes, though, who am I to tell you to switch it up?

Specialty Shoe Brands (Hoka, Altra, Brooks, Etc)

These are great shoe brands that most people only know about if they are avid runners. They each have characteristics that fit certain running styles or foot shapes better than others. They are not easily found (meaning you need to go into a specialty store to find them), so I don't often make recommendations regarding them. They are so specialized and individual that it really comes down to passing each of the tests, feeling right, and having the right use for them in mind. Most of my readers and patients are not that elite triathlete or ultra-marathoner with needs for niche shoes like these, so I generally only make recommendations about the most common shoes that are readily available and easy to find in your nearest sporting goods stores or shoe stores. Again, use the above tests. If they pass, try them out. If not, put them back on the shelf.

Dress Shoes

There are only a few brands that I know are common enough to make recommendations on. So many small companies make dress shoes that I could never make sweeping endorsements of individual brands. Rockport, Florsheim, and Stacy Adams are a few brands I have had positive experiences with, but as with all shoes, they have to pass my tests to be considered. Also, I'm a guy, so I'm not anywhere near familiar enough with female fashion to recommend a lot of brands for all the ladies out there. There are brands that I've known female professionals who recommend them, like Dansko and Landau. These are very individual because I've known people who LOVED them and other people who HATED them, so tread cautiously. Women, you have my sympathy; there are so many options for style out there that it's tough to make broad recommendations. Make sure the shoes pass the tests before proceeding.

Cleats and Specialized Athletic Shoes

Cleats are a very different animal from other shoes. They are designed to be very rigid, have efficient energy transfer from the ground to the feet, and generally aren't designed for comfort. It's a sacrifice of comfort for performance, so difficult to make broad recommendations and should be made on an individual basis. This is an area where Nike is actually one of my chosen brands. Football cleats are different from baseball cleats and soccer cleats, so one recommendation can't truly be applied across sports. The most important thing is that they fit like a glove and don't slide around, meaning that the previous rule-of-thumb about the space from the toe to the end of the shoe needs to be cut roughly in half. Different positions have different requirements, even, so a running back or defensive back will probably want something with a little more mobility, while a lineman will probably want more stability. Soccer players will likely want more flexibility as well. You probably know your own needs. If you're not sure, consult your coach for advice.

Wrestlers are an entirely different category altogether, because you'll NEVER find a pair of wrestling shoes that pass the Squish Test (I know, I wrestled in high school). They are designed to have lightness, grip, and flexibility of the shoe with sacrifice of support and stability. It's mostly about wrestling style, needs, and preference (although 90% of wrestlers I knew in high school went with Asics).

Diabetics

Diabetics have many risk factors associated with their feet, owing to diminished blood flow, damaged nerves/protective sensation, easily damaged skin, and decreased immune system. This makes foot care absolutely vital. The more advanced the complications from diabetes, the more important foot care and accommodation become. I typically recommend a soft shoe with even more space in the toes than my typical recommendation. The insole I recommend is soft and cushy, so that it protects the skin from blisters, calluses, or sores from forming. In advanced cases, I recommend custom made diabetic shoes that require a prescription. Either way, the recipe is soft and cushioned while maintaining some measure of support, as long as it doesn't cause its own complications. There is a lot more about the topic that I don't care to bore you with at this time, so I'll leave it at this: soft, cushioned, with a little more toe space than the average person.

Choosing shoe gear is both simple and complex at the same time. The basic principles I've discussed will help guide you, but I also don't have to wear the shoes every day. I'm happy to wear my gray, boring Asics because I favor function over style (and my work scrubs are gray, so there's that). I'm not a style guru and my primary objective with any patient is to give them the best functional outcome. This makes me favor function over anything else. I'm telling you to forego those cute flats in favor of Teva Sandals. I'm recommending functional Asics running shoes or New Balance cross-trainers over your sick Jordans. If you're a diabetic, I'm telling you to get the big, clunky, black shoes your grandpa wore. I'm also not your dad, so I'm not going to harp on you if you want to wear something cute for a night out with the girls, or flip-flops on an afternoon at the beach. Most of the time you should be wearing something that is going to help your feet, but for most readers your body was designed well enough to wear what you want every now and then.