How to Choose Shoes to Help Reduce Your Back Pain

Co-authored by Joel Giffin, PT, DPT, CHT

Last Updated: October 11, 2022 Approved

Back pain is a significant problem in the United States — more than 31 million Americans experience backaches at any given time and about 50% of workers claim having moderate-to-severe back pain every year. There are numerous causes of back pain, but many cases are related to poor posture and misalignment of the spine. Shoes are important for hip and spinal alignment because your feet form the base for the rest of your body. Getting new supportive shoes that accommodate the biomechanics of your feet can help reduce back pain depending on its cause. As such, it's important to understand the cause of your back pain and how your feet may be involved before buying new shoes.

Part 1

Part 1 of 2:

Identifying the Cause of Your Back Pain

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Identify the cause of your back pain. Schedule an appointment with your family physician if you develop back pain that won't go away after a few days of taking it easy. Your doctor will examine your back (spine) and likely ask you about your family history, job and lifestyle. If your back pain is severe, then x-rays of your spine might also be taken. Your doctor will try to rule out the most serious causes of back pain, such as a herniated disk, spinal infection, bone fracture, arthritis and cancer. Once those are ruled out, then considering how your posture, foot shape and shoe choices may be causing your back pain is appropriate.^{[1]
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Trustworthy Source

Mayo Clinic
Educational website from one of the world's leading hospitals

Go to source}
- Your family doctor is very likely not a back or spine specialist, so consider seeing an osteopath or chiropractor to diagnose your back pain as an alternative approach.
- Signs accompanying back pain that indicate you should immediately seek medical care include: muscle weakness and/or loss of sensations in your arms or legs, loss of bladder or bowel control, fever, sudden weight loss.^{[2]
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2
Check your arches. After you understand your back pain is not caused by a serious condition or disease, then look at your feet (particularly your arches) for a possible connection. Flat feet are a common contributor to back pain, especially for people on their feet frequently, because arches act as shock absorbers and prevent force from being translated up to other joints of the body.^{[3]
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National Health Service (UK)
Public healthcare system of the UK

Go to source} A good objective test to see if you have flat feet is the "wet feet" test. Dampen the bottoms of your feet with water and walk across a large piece of cardboard or thick paper that clearly shows your wet footprints. Make sure to get prints of both feet and examine them closely.^{[4]
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- A foot with a healthy arch will leave a heel print connected to the front forefoot by a strip about 1/2 the width of the foot on the outside of the sole. If you have flat feet, you'll see a print that reflects the entire underside of your foot with no space between the forefoot and heel.
- Both feet usually leave very similar footprints, but in some cases differences exist due to previous foot / ankle injuries or leg length differences.
- A 2013 study revealed that American women with flat feet are 50% more likely than those with normal or high arches to develop low back pain.
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3
Look at your posture. Looking at your posture in a full-length mirror is another good method to gauge if the shape or positioning of your feet, ankles and knees is potentially contributing to your back pain. While wearing shorts and standing straight, look at the angles of your feet, legs and ankles. If your feet point outwards, your ankles roll in (termed over-pronation) and/or your knees are close together or touch (termed genu valgum) then you are at much greater risk for back pain because these postures put more strain on the hips and lower spine.^{[5]
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Research source} People who are overweight tend to have all three postural issues, which partially explains why back pain is much more common in obese people.
- Over-pronation of the ankle, flat feet and genu valgum are sometimes hereditary (genetics control physiological development), but in many cases they are the result of the body carrying far too much weight.
- For reference, if your legs look fairly straight (at least a few inches between your knees), your ankles appear in a neutral position and don't collapse inwards (medially) and you can fit a few fingers underneath your feet while weight bearing, then likely other issues are causing or contributing to your back pain.
4
Be aware of inequalities in leg length. It's actually quite common to have one leg that is longer than the other – according to the American Academy of Orthopaedic Surgeons, one study found that 32% of 600 military recruits had a 1/5 inch to a 3/5 inch difference between the lengths of their legs.^{[6]
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Research source} However, any difference in length greater than this can have serious affects on your health, which may include lower back pain.^{[7]
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- Correcting a leg length inequality is easy to do with a shoe insert. It’s also inexpensive and can easily be stopped if no changes are seen. A foot doctor or health professional trained in assessing and treating the foot is the best option to assess your need for a shoe insert.^{[8]
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5
Examine your shoes. For further clues as to the cause of your back pain, take a good look at the soles of your most commonly worn shoes. For people with normal posture and biomechanics while walking, their heels strike the ground slightly on the outside or lateral edge, which causes wear on that area of their soles.^{[9]
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Research source} If the soles of your shoes appear to be worn directly in the middle of the heel area — or worse, on the inside or medial edge — then you likely pronate too much at the ankle while walking. As noted above, over-pronation and flat feet often go hand-in-hand and significantly increase the risk of knee problems, hip issues and low back pain.
- Wear patterns are easier to notice on well-used running shoes with rubber soles because they wear down quicker while walking / running on asphalt and cement.
- Keep in mind that wear patterns on the extreme outside (lateral) edge of the heels area indicate too much rigidity in your ankles and/or arches of your feet (termed over-supination). However, this type of posture is not linked to back pain nearly to the extent that over-pronation / flat feet are.^{[10]
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Part 2

Part 2 of 2:

Choosing Corrective Shoes

1
Buy shoes that fit properly. A significant number of people wear shoes that don't fit well, perhaps because the shoes were on sale or they're hand-me-downs, or various other reasons. Regardless, always wear shoes that properly fit your feet, not just in terms of length, but also in terms of width.^{[11]
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Trustworthy Source

Harvard Medical School
Harvard Medical School's Educational Site for the Public

Go to source} Wearing shoes that don't fit not only cause blisters, bunions and calluses, but they can reduce the stability and compromise the biomechanics of your feet and subsequently trigger back pain and other joint issues.
- Get fitted for shoes later in the day because that's when your feet are a little larger, usually due to swelling and slight compression of your arches.
- Most off-the-shelf shoes are regular (medium) width, so you may have to order shoes from the manufacturer if your feet are really narrow or wide.
- Some footwear may fit well, such as flip-flops, but they can still cause foot and other musculoskeletal problems due to the lack of arch and heel support.
2
Buy supportive shoes. Regardless if you have flat feet or not, wearing shoes with strong arch support is going to benefit your feet and improve your gait during walking / running at the very least. If your shoes don't support your arch properly, it can affect your back and lower extremities, especially if you already have pain in those areas.^{[12]
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Expert Source

Joel Giffin, PT, DPT, CHT
Physical Therapist

Expert Interview. 22 October 2020.} As such, when buying new shoes, look for a comfortable walking or athletic shoe with substantial arch support, roomy toe box, firm heel counter and a flexible sole. Buy quality and avoid trendy styles that look flimsy.
- Wearing flat sandals, flip flops and other slip-ons on the beach or around the pool is likely okay, but they shouldn't be used for extensive walking or any kind of exercise.
- Avoid shoes with heels higher than two inches because it changes the center of gravity and causes strain on the lower back. However, wearing completely level shoes may put too much pressure on your heels, so consider buying shoes that are elevated in the heel by about 1/4 or 1/2 inch.
3
Get an evaluation done before buying runners. If you are a regular jogger and think that your feet, shoes or running style may be causing your back pain, then get an evaluation done at a reputable running store. High-end running stores often employ people who are qualified to assess your gait, examine your feet and check the wear patterns on your shoes. These employees are not doctors, but they are usually experienced runners who can give you sound advice on what types of running shoes to buy, which can make a positive impact on your back pain. If you're a serious runner, you should be replacing your shoes every 350 to 500 miles or 3 months, whichever comes first.
- You may be asked to run over a force plate that's hooked up to a computer, or get video-taped jogging on a treadmill as part of your assessment.
- If you're an over-pronator, shoes with lots of medial support in the arch will likely be recommended to prevent ankle collapse. If you're an over-supinator, then more lateral (outside) support is needed to force your foot into a neutral position.
- Make sure the rigidity of the heel counter (back of the shoe) is vertical and not tilting to one side or the other. Shock absorption is also important for running shoes, which is why many brands have air pockets within the soles.
4
Get a pair of custom made orthotics. If you have flat feet and over-pronate, then you may be better off with custom shoe orthotics instead of new shoes. Orthotics are semi-rigid shoe inserts that support the arch of your foot and promote better biomechanics while standing, walking and running.^{[13]
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Research source} By providing cushioning and some shock absorption, orthotics will also reduce the likelihood of problems developing in other joints such as your ankles, knees, hips and spine. Health professionals who make custom orthotics include podiatrists, as well as some osteopaths, chiropractors, physicians and physical therapists.
- You should realize that orthotics don't reverse any structural deformities of the foot nor can they reconstruct an arch by wearing them over time.
- When wearing orthotics, you'll likely need to take the factory insoles out of your shoes first.
- Custom orthotics can be expensive without medical coverage, but off-the-shelf insoles may provide relief for back pain also.
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What kind of shoes do I need if I have lower back pain?

Joel Giffin, PT, DPT, CHT
Physical Therapist
Dr. Joel Giffin is a Doctor of Physical Therapy and the Founder of Flex Physical Therapy in New York, New York. With over 15 years of experience as a Certified Hand Therapist (CHT), Dr. Giffin treats the whole body and specializes in rehabilitation of the hand and upper extremities. He has treated Broadway theater performers backstage at shows such as The Lion King, Sleep No More, Tarzan, and Sister Act. Flex Physical Therapy also specializes in occupational and pelvic floor therapy. Dr. Giffin earned his Master’s degree in Physical Therapy with honors from Quinnipiac University and received his Doctor of Physical Therapy (DPT) degree with distinction from Simmons College. He is a member of the American Physical Therapy Association and the American Society of Hand Therapists.

Joel Giffin, PT, DPT, CHT

Physical Therapist

Expert Answer

If you're already having back pain, I'd recommend something that has more of a soft sole and possibly arch support. The way your foot functions can affect your lower extremities, hips, and back. However, it's not always best to use those types of shoes to prevent back pain, because sometimes they can actually weaken some muscles, making you more prone to pain.

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Tips

To maintain good posture when sitting and reduce your risk of back pain, choose a firm chair, preferably with armrests. Keep your upper back straight and your shoulders relaxed. A small cushion behind your lower back can be helpful in maintaining the natural curve of your lumbar spine. Keep your feet flat on the floor, using a footstool if necessary.^{[14]
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To maintain good posture when standing and reduce your risk of back pain, stand with your weight equally distributed over both feet and avoid locking your knees. Tighten your stomach and butt muscles to keep your back straight. Wear supportive shoes while standing for long periods of time. Alleviate muscle fatigue by periodically resting one foot on a small footstool.

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Don't wear other people's shoes (eve if they're high quality and supportive) because they're already molded to their feet and arch shape.

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