For better or worse, your shoes can play a major role in your arthritis symptoms. Some types can aggravate foot pain and add stress to your joints; others can help relieve arthritis symptoms.
When the hot days of summer arrive — along with paper-thin ballet flats or flimsy flip-flops — it can take time to find footwear that doesn’t put undue stress on your feet or exacerbate your arthritis pain.
“If you have existing arthritis, you need to invest some effort — but not necessarily much money — in finding good, supportive summer shoes,” says Rebecca Cerrato, MD, FAAOS, an orthopedic surgeon at The Institute for Foot and Ankle Reconstruction at Mercy Medical Center in Baltimore, Maryland.
There’s not one “perfect” type of shoe for arthritis. The best shoes to pick will largely depend on where your arthritis is located, so it’s best to check with your rheumatologist or podiatrist for specific guidance. For instance, while those with arthritis in the feet may want to aim for a rigid, structured shoe, those with knee arthritis are likely to benefit from a thinner, more flexible build.
Managing your pain levels through proper footwear can play a big role in how active you can be this summer. As you already know, physical activity is important for increasing strength and flexibility, reducing joint pain, and combatting fatigue when you live with arthritis, per the Mayo Clinic.
Here, learn how eight common types of summer shoes may generally affect arthritis symptoms, and how to choose the best shoe for you.
Sandals and Flip-Flops
These are infamously known for being tough on your feet, particularly if they’re the thin, rubbery type that you might wear in a gym shower or on the beach.
“For someone who has arthritis, very flat and thin flip-flops provide very little support,” says Dr. Cerrato. “But there are some flip-flops that have a cup in the heel and a little more substance for shock absorption, and those do offer more support.”
If you have arthritis in your feet, thong flip-flops (the kind in which a strap threads between your toes) may be particularly uncomfortable or exacerbate your pain.
“It can be harder for those with arthritis in their big toe to grip with that toe while walking in thong flip-flops,” says Dr. Cerrato. “Meanwhile, a lot of patients with mild bunions prefer open summer shoes because they don’t rub against the bunion. But if you have really large bunions, flip-flops can still be difficult.”
If possible, look for a sandal that has a strap around the ankle. This helps secure the shoe to your heel, which offers additional support.
Meanwhile, despite a structured shoe being best for your feet, a thinner model may be ideal if you have arthritis in your knee.
“If your feet don’t cause you difficulty but your knees are really limiting you, then you should buy something that’s close to barefoot posture, which is the best for knees,” says David Felson, MD, MPH, a professor of medicine at Boston University School of Medicine and a rheumatologist at Boston Medical Center. “Barefoot posture doesn’t force certain positions that increase the load across the knee.”
When to wear them: Sandals and flip-flops are best for short walks or sitting poolside. Avoid them for long-distance walking, particularly if you have arthritis in your feet. Thong flip-flops are best for slipping on and off quickly, such as at the pool or beach.
These shoes typically cover the forefront of the foot while leaving the heel exposed. Some clogs feature straps while others do not.
“Clogs can be really helpful for people who have heel pain,” says Dr. Cerrato. “For instance, if you have Achilles tendonitis, they won’t rub against that painful bump on your heel [if there’s no strap].”
However, research has found that clogs can increase joint stress if you have arthritis in your knee. In a small study published in the journal Arthritis Care & Research, researchers studied the gait of participants with knee osteoarthritis wearing four different shoes: clogs, stability shoes, flat walking shoes, and flip-flops. Overall, the clogs and stability shoes increased loads on the knee joints by up to 15 percent compared to flat walking shoes, flip-flops, and barefoot walking.
When to wear them: It may be best to skip clogs if you have knee arthritis. Otherwise, clogs are best for walking short distances or while sitting, such as outdoor dining. Avoid wearing them to walk for exercise or in areas with uneven terrain, like a farmer’s market on a dirt road.
These slip-on shoes can vary widely in terms of support. If you have arthritis in your foot, a more rigid build may be best.
“Some espadrilles are very flimsy and the base has very little support,” says Dr. Cerrato. “But I’ve seen other styles in which the base of the shoe is substantial and has arch support, and those can provide arthritis patients all the support they need.”
How to tell? If you can bend the shoe easily, it may not provide the support one with more rigidity might. That said, Dr. Felson points out flexible shoes may be better for those with knee arthritis.
“Shoes that are designed with arch support provide a better cushion for the entire outline of the foot,” says Dr. Cerrato. “The benefit of having that support is that it prevents the arch from collapsing down as you’re walking.”
This is important to consider if you have rheumatoid arthritis in your feet, which puts you at greater risk of flat feet. As the disease progresses, the alignment of the foot can shift into a flatfoot deformity, per the American Academy of Orthopaedic Surgeons. This may cause pain and discomfort along the main tendon that supports the arch on the inside of the ankle, or on the outside of the ankle.
Supportive espadrilles may be a good choice if you want a sturdy shoe other than an athletic sneaker. Espadrilles also have the benefit of staying secure to your foot, so you don’t need to worry about gripping the shoe if you have arthritis in your toes.
When to wear them: If you find supportive espadrilles, you can wear them for shopping, doing light housework, or strolling through a city. Opt for more flexible espadrilles if you have knee arthritis.
Oftentimes, ballet flats are designed to be quite thin and narrow, which may pose problems if you have arthritis in your foot.
“Classically, these shoes don’t provide any support to the bottom of your foot, and are often designed to be very narrow,” says Dr. Cerrato. “If arthritis patients aren’t getting the width they need, these shoes can cause a lot of discomfort for bunions.”
The skin over bunions may already be red and sore, and wearing tight and narrow shoes might make bunions worse, per the Mayo Clinic. In fact, bunions can develop not only as a result of arthritis-related changes to the foot, but also from wearing narrow shoes alone.
Although bunions typically form on the joint at the base of your big toe, smaller bunions can develop on your little toe joint, which narrow shoes also exacerbate.
When you’re shoe shopping, look for an extra-wide shoe if needed: Wide toe boxes can also accommodate hammertoes and other joint deformities that may accompany rheumatoid arthritis or osteoarthritis.
When to wear them: Avoid ballet flats if you’re going to be walking. “I’ve seen many patients come in with stress fractures because they wore ballet flats during, say, a walking tour of Washington, D.C.,” says Dr. Cerrato. These shoes are best for dining at a restaurant or lounging in the backyard.
Heels and Wedges
Although heels are widely considered harmful for foot health, they vary widely in terms of material and design. For instance, heels made with high-quality leather may stretch and be more forgiving on your toes than those made with plastic. A block heel may provide more support than a thin stiletto.
“Heels tend to be really uncomfortable for patients with big-toe arthritis,” says Dr. Cerrato. “And the thinner the heel is, the more you have to balance to keep yourself upright. That means your ankles are working overtime.”
High heels are also a risk factor for bunions, because they often crowd your toes (especially if you wear a pointed-toe style).
“Heels, in just about every circumstance, are not good for the feet or knees,” says Dr. Felson. “They put too much load on the ball of the foot, and that can cause arthritis later or increase your arthritis pain now. They also increase the load on your knees.”
Knee osteoarthritis is about twice as common in women compared to men. A 2015 study published in the Journal of Orthopaedic Research found that high heels may contribute to this increased risk in women.
However, if you do want to wear heels, Dr. Cerrato notes that wedges may offer more support than a standard heel. “Some have a little bit of a platform under the foot so the heel height isn’t as great, and you can get away with what looks like a higher heel but isn’t,” she says.
When to wear them: Heels are best saved for short walks around an office or special events. Avoid wearing them on uneven terrain.
Athletic sneakers tend to offer the best support for your feet while you exercise, and you can now find a wide variety of athletic shoes customized for your foot shape and the activity you spend the most time doing.
“Companies have designed shoes for people who need more shock absorption in the back of the shoe, and shoes that are much more rigid and stiff,” says Dr. Cerrato. “For patients who have arthritis in the big toe, that rigidity provides a lot more comfort when they’re walking or running because it minimizes the motion through the toe.”
However, you should avoid sneakers with built-in stability if you have knee arthritis.
Some athletic shoes (and other types of shoes like sandals, for that matter), feature slightly curved soles that can gently move you through your gait, which reducing strain on your foot, ankle, and toes as you walk.
You can also find casual sneakers with arch support and heel cushion, but beware that some may not have the same level of support for the foot as athletic sneakers. These casual sneakers may not be suitable for exercising or long walks.
When to wear them: Athletic sneakers can be used for exercising, city walking tours, and navigating uneven terrains. Avoid sneakers with built-in stability if you have knee arthritis.
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Bunions. Mayo Clinic. June 18, 2020. https://www.mayoclinic.org/diseases-conditions/bunions/symptoms-causes/syc-20354799.
Exercise helps ease arthritis pain and stiffness. Mayo Clinic. June 18, 2020. https://www.mayoclinic.org/diseases-conditions/arthritis/in-depth/arthritis/art-20047971.
Interview with David Felson, MD, MPH, a professor of medicine at Boston University School of Medicine and a rheumatologist at Boston Medical Center
Interview with Rebecca Cerrato, MD, FAAOS, an orthopedic surgeon at The Institute for Foot and Ankle Reconstruction at Mercy Medical Center in Baltimore, Maryland
Rheumatoid Arthritis of the Foot and Ankle. American Academy of Orthopaedic Surgeons. June 18, 2020. https://orthoinfo.aaos.org/en/diseases–conditions/rheumatoid-arthritis-of-the-foot-and-ankle.
Shakoor N, et al. The Effects of Common Footwear on Joint Loading in Osteoarthritis of the Knee. Arthritis Care & Research. July 2011. doi: https://doi.org/10.1002/acr.20165.
Titchenal MR, et al. Effects of high heel wear and increased weight on the knee during walking. Journal of Orthopaedic Research. December 22, 2014. doi: https://doi.org/10.1002/jor.22775.