Shoes to help you put your best foot forward
Tips for finding footwear that is comfortable, safe and fashionable
by Vicky Uhland
In November 2022, actor Christina Applegate was honored with a star on the Hollywood Walk of Fame. She attended the ceremony barefoot.
“For some with MS the feeling of shoes may hurt or make us feel off balance. So today I was me. Barefoot,” tweeted Applegate, who shared her multiple sclerosis diagnosis with the public in 2021.
Applegate is not alone. “I go barefoot in the yard and house as much as possible — I have since I was a kid,” says Naomi Leydig, who was diagnosed with MS in 2011. “There’s something about being barefoot that grounds me.”
And B Morse Lynch posted on the National Multiple Sclerosis Society Facebook page that she also goes barefoot whenever she can. “I have better balance with nothing on my feet,” she says. “With shoes on, I can and do trip over my own feet.”
Yet no matter how much they may want to go barefoot, sometimes people living with MS simply have to put on shoes. But choosing the right footwear can be challenging. Along with finding shoes that are comfortable, you may also need footwear that works with orthotics, or accommodates your balance issues, spasticity or foot drop.
Add to that the lack of stylish shoes that can meet those needs, and it’s no wonder that some people with MS would rather go shoeless. But it doesn’t have to be that way, says Susan Linder, a physical therapist and director of clinical research, physical medicine and rehabilitation at the Cleveland Clinic in Ohio.
“Many people with MS deal with things like pain, spasticity, toe curling or balance problems,” she says. “The shoe type they consider can impact those issues. A poor-fitting shoe can worsen those issues, while a good-fitting shoe can help manage them.”
Linder and Kaitlin Sparks, a physical therapist at the Cleveland Clinic Mellen Center for Multiple Sclerosis, offer the following checklist for people with MS who are searching for comfortable, safe and even fashionable footwear.
Start by knowing your shoe size
Decades ago, salespeople would whip out metal gadgets that measured your foot length and width before you tried on shoes. But today, sizing has gone high tech.
“Some shoe stores do pressure mapping that looks at not only the width and length of your foot, but also where your arches fall and where you bear weight throughout your feet,” Linder says. “This helps determine what shoe type would be best to accommodate you.”
Athletic-shoe stores usually have pressure-mapping capabilities, Linder says, as do stores that specialize in shoes for people with foot issues. Even drug stores can have pressure-mapping kiosks affiliated with some orthotics brands.
Consider your orthotics or braces
Orthotics or braces that are custom made for you may be difficult to insert into shoes. Leydig has worn custom orthotics since 2017 to help with back issues and had them trimmed so they would fit into her shoes. But that’s not possible with all types of orthotics, Sparks says.
“I sometimes recommend going up a size or half a size when wearing an AFO [ankle foot orthosis],” she says. “Carbon fiber AFOs are easier to fit into your regular shoe and can be trimmed down easier than plastic AFOs. You can work with your physical therapist and orthotist to figure out which option is the best for your situation.”
If you need to order a single pair of shoes in two different sizes, some brick-and-mortar or online stores allow that for a reasonable fee. Do an internet search for “single shoes” or “split shoes” to find them.
Evaluate the inserts
No matter what type of shoe you choose, Linder says the insole should contact all parts of the sole of your foot, especially the arches. This usually isn’t a problem with athletic shoes, but dressier or more fashionable shoes tend to have inadequate inserts or none at all.
“If you take out the shoe’s insert and it lies flat on the table, that’s not good,” Linder says. “A good insert supports every part of the foot and rises up to meet the arches in the foot rather than having the foot sink down into the insert. It can turn a lesser-quality shoe into a good-quality shoe.”
If you find a must-have pair of shoes with inadequate inserts, don’t despair. You can buy over-the-counter contoured inserts to support your foot or have them custom made by an orthotist or podiatrist. When looking for standard inserts, consider ones made for plantar fasciitis, Linder says.
Support your heels
Along with the arches in your feet, your heel also needs to be cupped or supported. That’s why flip flops give physical therapists nightmares — and people with MS safety issues.
Lindsey Fowler, who was diagnosed with MS in early 2022, found that out the hard way.
“I grew up living in flip flops. But now, I can’t feel my feet very well, I have foot drop and I have balance issues. I walk like I have flippers on,” she says. “I got really depressed because I just couldn’t keep those darn flip flops on. I discovered I have to have shoes with closure in the front and back.”
Linder says heel support is also important if you have spasticity or toe curling. And if you have ankle issues, short boots can offer even more stability and accommodate a brace.
While a closed heel is best, Sparks says sandals can work as long as they have a back strap that holds your heel in place. Backless slide-on shoes or slippers can be easy to trip over or fall off your foot. “If you want to wear slippers, try moccasins,” she suggests.
Teri DiCecco posted on the Society’s Facebook page that she even wears her slippers outside. “I wear very soft ones with no hard sole, so I don’t get foot spasms,” she says.
Don’t go too high
Shoes with heels can cause a host of problems in people with MS, Sparks says. Because they tilt your body forward when walking, they may exacerbate balance issues. They usually don’t offer much ankle support and may lead to contracture in the ankle, which is an issue for people with spasticity.
Both Sparks and Linder recommend limiting heel height to 2 inches or less. The heel should be a block rather than spike style, to offer more support. Linder also recommends wedge heels to provide a good base to walk on. However, Sonia Norenberg posted on Facebook that she can’t wear wedges at all.
“I’ve fallen out of them and sprained my ankle twice,” she wrote. “I still like to wear a dress shoe with a small heel. The stack or block heels work well for me because the large heel provides balance.”
Platform heels can also be problematic, wrote Jessica Darsey Tribble on Facebook. “I can wear shoes that have 1-inch to 2-inch block heels on them, but if the whole shoe is a platform style, I can’t keep my balance. There’s something about not being able to feel the ground under the front part of my foot that throws my balance off.”
One overlooked aspect of shoe selection is the type of tread. Linder says there needs to be sufficient traction so you don’t fall, but too much traction might cause you to catch a toe while walking.
“Don’t get too bulky, like a hiking shoe, but avoid leather bottoms that can be slippery, unless you drag your feet. Then you might consider a leather bottom when you’re at home,” she says.
Lisa Downing posted on Facebook that she avoids shoes with too much traction, including toe guards or other tough material in the toe area. “I need to ‘feel’ the floor,” she says. “On weak days, I drag my foot, so too much traction means my feet won’t move forward. I may grind the toes if they do move. Walking on carpet is a nightmare in sneakers. I prefer soft-soled leather slippers or [being] barefoot.”
Nicki Sinclair also considers her toes when shoe shopping. “The most important feature is an upturned toe,” she wrote on Facebook. “It helps the foot move naturally and aids those of us suffering occasional foot drop.”
Shoes with heavy treads can also add bulk, which can be problematic. “I tend to do better in lightweight shoes in regard to stumbling/tripping, etc.,” Carol Jean Frazier wrote on Facebook.
Think about how a shoe fastens
Lindsey Fowler says that due to her balance issues and difficulty bending over, simply putting on shoes was so taxing that it limited her from leaving the house. “It sounds crazy but changing to shoes I could just slip on gave me independence and confidence.”
Fowler likes the new type of slip-on sneakers that have a firm heel. “Major shoe manufacturers are now making adaptive shoes that slip on easily and come with a reinforced heel, so you won’t trample down the back of the shoe,” Linder says. “One shoe even hinges upward to allow the person to slip his or her foot in, then push down.”
If you want something dressier, Linder suggests looking for shoes with zippers, which are easy to put on but can appear stylish rather than orthopedic. There are also slip-on shoes with elastic laces that fasten to a Velcro piece but look like regular shoelaces.
Another option is traditional slip-on shoes like loafers or ballet flats. Just add an insert and choose styles with uppers that reach at least halfway up your foot, which helps keep the back of the shoe from sliding off, Sparks says. “Otherwise, if you have sensory issues, you may not notice if a part of your shoe comes off.”
Don’t give up on fashion
The bottom line is that comfortable and safe shoes don’t have to be ugly or expensive. And you don’t have to limit yourself to just a few pairs.
Tina Morehead, who uses a walker due to balance issues, keeps a wardrobe of footwear depending on how her day is going.
“I need heavier soles to be able to drive, so I’ll get somewhere in Mary Janes with Velcro straps and change into stylish velvet slippers — although sometimes I just do hospital socks,” she wrote on Facebook.
Linder says doctors, orthotists or physical therapists may recommend clunky, unattractive shoes because they don’t know that shoe manufacturers are now making adaptive footwear that looks mainstream.
“Or you can take a shoe you like and make it work through inserts, Velcro or elastic laces,” she says. “There are more footwear possibilities for people with MS than you might think.”