Todd P Krell, MD
Fellow of the American Academy of Orthopaedic Surgeons
http://orthodoc.aaos.org/ToddKrellMD
Westfield Orthopedic Group
541 East Broad Street
Westfield, NJ 07090
Phone: (908)232-3879  | Fax: (908)232-5789
Copyright 2012 American Academy of Orthopaedic Surgeons
Tight Shoes and Foot Problems

As online shopping grows in popularity, there is a greater temptation to purchase, keep, and wear shoes that look fashionable, but may not fit properly.

As a result, many adults are wearing shoes that are not appropriate for their foot shape and size. Women especially are more likely to purchase a shoe that is too small, putting them at risk for corns, bunions, and other deformities that may require surgery to correct.

Toe Deformities

Bunion

A bunion is an enlargement of bone or tissue around the joint at the base of the big toe. As the bunion grows, the big toe may turn in toward the second toe and cause swelling and pain with shoe wear.

A bunion is a bony knob that protrudes from the base of the big toe.

Although genetic factors may play a role in whether you develop bunions, in most cases, bunions are widely attributed to wearing shoes that are too tight.

Nonsurgical treatment involves wearing shoes with a wider toe box, wearing a spacer between your big and second toe, taping your toe, and/or applying ice to your toe. If these simple treatment measures are not effective, your doctor may discuss surgery to remove the bunion.

Corn

Some corns are found between toes where the toes rub together.

A corn is a type of callus that develops when tight shoes put constant pressure on the skin.

Simple treatment involves applying a foam pad over the corn to help relieve the pressure. In addition, wearing shoes that fit properly and have a roomy toe area will help.

Hammer Toe

Hammer toes occur when the toe starts to curl up instead of lying flat. The middle toe joint will bend up and if you have your foot in a tight shoe, it will rub up against the shoe surface and cause pain. In addition, the muscles that attach to the toes will continue to weaken if the foot stays in this abnormal position.

A hammer toe often develops a corn on top of the bend, adding to the discomfort.

Simple treatment options include strapping techniques, wearing shoes with a wider toe box, wearing toe splints, and applying ice to the affected area. If these techniques are not effective, surgery to correct the deformity may be an option.

Crossover Toe

A crossover toe forms when the toes are crimped in a toe box that is too small, and the constant pressure causes the second or third toe to move over the toe next to it.

Simple treatment consists of wearing shoes with a wider toe box, using spacers or taping to keep the toes apart, and applying ice to the affected area. If this conservative treatment fails, surgery may be an option.

Ingrown Toenail

An ingrown toenail usually occurs in the big toe when the nail is cut short near the tip of the toe. This injury may be aggravated when you put your foot in a shoe that is too tight in the toe box, causing your first toe to be pressed against the second toe, and resulting in abnormal pressure on the nail. The constant pressure results in inflammation and nail pain.

Simple treatment involves wearing a shoe with a wider toe box and soaking the toe three to four times a day in warm water. Trim your toenail straight across and avoid trimming the corners of too short.

Diabetic Foot

People with diabetes often suffer from nerve damage (peripheral neuropathy) in the foot and are not able to feel skin irritations, or even punctures. If a shoe is too tight on their foot, it may result in blisters or sores that can quickly progress to serious infections.

If you are diabetic, check your feet daily for pressure areas, redness, blisters, sores, scratches, and nail problems.

Shoe Selection for Foot Problems
  • When trying on a new shoe, make sure that your toes do not feel pinched or cramped, and that none of your toes are pushed over another toe.
  • Ask the salesperson to measure the length and width of both of your feet to ensure a proper fit.
  • Do not buy shoes that do not fit. There is no such thing as a "break-in period." With time, a foot may push or stretch a shoe to fit. But this can cause foot pain and damage.
The goal is to find a shoe that approximates the shape of your foot - rather than for your foot to take on the shape of the shoe.
  • Evaluate the shoe for its overall construction. The shoe should bend in the toe box, not the shank (arch). A good stable shank will provide you with more support. You should not be able to easily squeeze the heel counter in on a new pair of shoes. Is the heel counter shallow or does it sit higher on the heel providing more stability for your foot? What is the shape of the toe box?
  • Determine if the toe box is appropriate for your foot. It is not just the shape of the toe box but also the depth. A deeper toe box will have more room to accommodate a bunion, hammertoes, and a wide forefoot. A square toe box is the most desirable shape. If you are unable to get a square toe box, a round one is a better choice than a pointed shape.
Wear shoes and socks that fit and give your toes plenty of room.
  • Shoes that lace, buckle, Velcro or have some type of strapping mechanism will provide more support to your arch.
  • A shoe that has a removable insole is ideal so that you can add an orthotic or more cushioned insole if needed.
  • Shoes that do not have the tongue attached to the upper of the shoe will provide a better fit. It is difficult to add an extra insole or orthotic to a shoe with the attached tongue.

For more helpful guidelines about choosing proper footwear: Shoes: Finding the Right FitShoes: Finding the Right Fit (topic.cfm?topic=A00143)

Last reviewed: August 2012
AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS "Find an Orthopaedist" program on this website.
Copyright 2012 American Academy of Orthopaedic Surgeons
Related Links
Shoes: Finding the Right Fit (http://orthoinfo.aaos.org/topic.cfm?topic=A00143)
Bunions (http://orthoinfo.aaos.org/topic.cfm?topic=A00155)
Hammer Toe (http://orthoinfo.aaos.org/topic.cfm?topic=A00160)
Corns (http://orthoinfo.aaos.org/topic.cfm?topic=A00153)
Care of the Diabetic Foot (http://orthoinfo.aaos.org/topic.cfm?topic=A00148)
Ingrown Toenail (http://orthoinfo.aaos.org/topic.cfm?topic=A00154)
OrthoInfo
The American Academy of Orthopaedic Surgeons
6300 N. River Road
Rosemont, IL 60018
Phone: 847.823.7186
Email: orthoinfo@aaos.org

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