What is normal shoe wear?

Shoe wear is interesting. It tells a wonderful story how the human frame interacts with the ground. I often check out the wear patterns of my patients especially when they are complaining of foot, ankle, knee or hip pain.
Here are some basics to look for when it comes to ‘normal’ wear patterns.

1. Wear is normal and it should exist.
2. The outside of the heel should be the first place of contact and shoes should exhibit this natural wear pattern.
3. Toe off should be through the big toe and therefore wear patterns should generally be seen from the outside of the heel and through the big toe.

How much pronation is too much?

Pronation is the ‘giving way’ motion to reduce shock. It is normal for your foot to have some ‘falling’ of the medial arch as your foot is exposed to the shifting weight of the body. The arches act like little springs, controlled by muscles, ligaments and joint alignment. There is a little test I perform called the navicular drop test that gives me a general idea how much the foot drops with load. However, this is only a basic guideline. Normal dropping of the navicular (the bone that sticks out a little more in the middle to inside of your foot) should be 3-4mm. But this is only a ballpark ‘normal’ range. Other factors need to be considered as well.
In my office I offer custom orthotics. This is usually only prescribed when all other natural strategies are exhausted like adjusting the foot bones. There are also short foot exercises but I have found those are only helpful in certain cases and if the patient is compliant in doing them. But if custom orthotics are warranted, a non weight bearing casting technique is used to generate an identical mold of the foot as to catch the non-weight bearing state of the foot. This is the choice casting method recommended by the Canadian Podiatry Association and this makes sense. You want to cast the foot not in its weight-bearing state. If you do, you are just guessing where the bones should be.

So, pay attention to your shoe wear. It might just indicate what is going on with your body.


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