Old Soldier Tom's Journal.                  

Start with the right size. Most people automatically shop for new shoes that are the same size as their last pair. That's a mistake. Shoe sizes vary by manufacturer, and an adult's foot can grow up to one full size larger with age.

For proper-fitting shoes: Have your feet measured while standing, try on both shoes and walk around the store. Check that the shoe comfortably fits across the ball of your foot while still holding the foot snugly. Be sure that your toes have plenty of room to move, both in width and at the tips.

If one foot is larger than the other, always buy for the larger foot. If the shoe on the smaller foot feels too big, use a cushioned inner sole, available at shoe stores and pharmacies.

While shopping, wear the same type of socks you expect to wear with the shoes. Cotton socks are the best because they don't slip and they keep feet dry. If you plan to use prescription orthotics (custom-made shoe inserts molded to fit your foot), wear them when trying on the shoes.

Important: Since feet tend to swell during the day, shop in the late afternoon or evening.

Choose the right kind of shoe. Rubberized soles provide optimal cushioning and traction. Lace-up shoes are always more stable than slip-ons or sandals because tension can be adjusted to give more support. For maximum support and stability, pick a shoe with an upper made of leather or canvas that holds its shape, rather than soft nylon or sheepskin.

To prevent slips and falls during winter: Wear snow boots with rubber soles that contain grooves to channel snow and ice.

Also helpful: Wear Yaktrax, stretchable coils that can be placed over the soles of shoes or boots to provide traction. They are available at outdoor sports stores for about $20 a pair.

Good shoes for general wear: "Comfort" shoes, designed to look like regular dress shoes but with more cushioning inside and the stability and traction of an athletic shoe, such as those made by Fila, Aerosoles, etc.... a cross-training shoe (a general type of sneaker suitable for all sports)... or a running shoe, provided it's flexible enough that you can bend the sole in your hands fairly easily.

Wear shoes at home. No more going barefoot at home. New finding: A two-year study of 1,300 people age 65 or older found that those who didn't wear shoes indoors were 10 times more likely to have a fall in their home. And of the shoe-wearing group, the odds of falling were 30% greater in ordinary shoes than in athletic shoes or canvas sneakers.

Don't wear shoes that are worn or cause pain. Even a small amount of wear in the heels or soles can affect the way you stand and/or walk. If your shoe shows inconsistent wear, which can cause you to become unbalanced, discard the shoe or have the heels or soles replaced. (Typical cost: $10 to $25.)

If a shoe is causing pain, stop wearing it immediately. Aching or soreness in your heel, arch or elsewhere is usually caused by excess strain or pressure on some part of your foot -- a clear sign that a shoe isn't right for you. If the pain persists, a podiatrist can treat the injury, guide you to a safer choice in shoes and/or give you tips on how to lace your shoes to relieve pressure on your feet. To locate a podiatrist in your area, contact the American Podiatric Medical Association, www.apma.org.

Avoid high heels. Heels that are two inches or higher are more likely to lead to bunions, foot pain and postural problems than lower-heeled shoes. Spend no more than two hours a day in high heels.

If the top of your foot hurts: Use the "loose-tie" method. Begin to lace your shoes with a single criss-cross. Then thread straight above one or two holes, criss-cross at the top and tie.

If your heels slip: Try the lace-lock method. Lace your shoes as you ordinarily would -- but thread the final two holes (near your ankle) without criss-crossing the laces. Then thread the laces in an X-shape and tie.

Bottom Line/Health interviewed Edward Buro, DPM, a podiatrist in private practice in Comack, New York, and president of the New York State Podiatric Medical Association. He is also director of medical education at North Shore University Hospital in Forest Hills, New York.