In between technically difficult ankle surgeries and dermatology-heavy diabetic wound care, podiatrists spend a lot of time talking about shoes. Most people take them for granted; they’re just another part of your morning routine — something you slip on as you leave the house without realizing they could seriously affect your feet.
In fact, your shoes are quite literally the foundation for your entire day. A good shoe will cup your heel and hold it in a proper alignment to support the weight coming down through your leg and ankle. Good arch support (whether built into the shoe or added with a pair of orthotics) will keep your feet from feeling “tired” by the time you get home and can prevent tendinitis or plantar fasciitis. A wide, accommodative front (the “toe box”) will prevent irritation on the skin of the toes, blisters and other sore spots.
Many of my patients are disappointed when I scold them for wearing high-heeled or unsupportive shoes. They come to the doctor asking for a solution to their foot pain, but are unhappy when I tell them their poor shoe choices are a large part of the problem. I’ve even had women ask for orthotics to put in their stilettos to make them more comfortable. (Unfortunately, short of using a magic wand, there are some shoes that will never be comfortable.)
The bad news: just like having poor eyesight, having foot pain means you need some correction. Instead of a pair of eyeglasses, you need supportive shoes. If you have 20/20 vision, there's no need for glasses. If you have no foot pain and your feet tend to be anatomically balanced, you can get away with wearing less supportive shoes without immediate painful consequences. If you do have foot pain or other problems, such as bunions or hammertoes, then you need to spend the majority of your day in good, supportive shoes.
The good news: I said you need to spend "the majority" of your day in supportive shoes — not "all day." I am completely aware that you cannot wear athletic shoes to a wedding or on a first date to a nice restaurant. This is why I have termed the unsupportive flats or heels "dessert shoes."
If you ate chocolate cake all day long, it would negatively affect your health, and the same is true for unsupportive shoes. But if you eat good, nutritious food at each meal, you can splurge and have a little piece of cake after dinner. Wear good shoes (with orthotics if you need them) all day, and then slip into your heels for two hours while you’re out with your friends.
Most people don’t realize the impact shoes have on their gait, stature and foot health. I’ve often been asked, “Are my shoes really that important?” Well, several studies have been done in the past 10 years that examine the effects of different shoes when walking, running and regular daily activities. An article in Arthritis Care and Research in 2009 studied more than 3,000 individuals and found that women who wore supportive shoes were 67 percent less likely to have heel and hind-foot pain later in life. This is a great argument for wearing supportive shoes even if you’re not having symptoms yet. Most women in their 20s are able to wear heels or unsupportive flats without pain, but the long-term consequences may be arthritis, hammertoes or tendinitis.
Another study published in the Journal of Experimental Biology in 2010 noted significant changes in the length and stiffness of several calf muscles in women who wore high heels regularly. With a shortened Achilles tendon you’re more likely to suffer from plantar fasciitis (a common cause of heel pain) and inner ankle tendinitis, and it even can play a part in the formation of hammertoes.
So, by all means, grab that pair of Jimmy Choos or Steve Madden heels. Just remember — everything in moderation. You need to earn that time in your “dessert shoes” by wearing healthy, supportive alternatives the majority of your day.
Of course, some foot discomfort stems from more serious issues, so if switching to supportive shoes doesn’t solve your pain, see your podiatrist to find the cause.

Putnam is the lead podiatrist for Atlantic Foot and Ankle Specialist.