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Heel Slippage… No Simple Solution

I’ve been fitting shoes now for the better part of 37 years, and—without a doubt—heel slippage is the most challenging issue we face when fitting women’s footwear.

Most believe that it is caused from an unusually narrow heel (something that those of a certain generation appear to take great pride in). This common foot profiling comes as a result of being fit in a dress shoe store, where the salesperson tells the customer that they have a narrow heel (for example, a 2A forefoot with a 6A heel). This kind of statement is made even though there has never  been—to my knowledge—a device designed to measure heel width.

Whether the heel can be measured or not, the use of a combination last can be important when fitting most pump-style shoes. In the case of this style of footwear, there are really only two places the shoe can hold on to the foot: the heel and the toe. The fact that there is no material over the instep leaves only one strategy for keeping the shoe on—i.e. squeeze the foot and hope it doesn’t hurt!

But a good fit and limited heel slippage are far more complicated than just a tight heel and toe fit.

In fact, with most athletic and orthopedic fits, we are trying our best to actually avoid a tight toe box. The resulting roominess up front makes keeping the heel in place even more challenging.

In these cases, a good heel fit is only possible by having a snug and customizable fit over the instep. That is why a lace-up shoe should fit better than Velcro, Mary Jane, or slip-on options.

Here are some ways to improve heel fit while still allowing for ample toe room:

  • Snug up the laces over the instep.

  • Make use of the top eyelet.

  • Lock or loop-lace the top lace holes (see a video demo on this technique here).

  • Adhere a tongue pad to the inside of the tongue—this creates a snugger fit over an otherwise sloppy instep. It can also act as additional padding, so that the laces can be pulled tighter without bruising the dorsal aspect of the foot.

  • Consider having an additional eyelet punched out in casual shoes, so the shoe can be laced further up, closing the gap around the ankle (this can be done at a shoe cobbler or in our shop while you wait).

  • Adhere ‘heel grips’ to the inside of the heel counter. Have these contact-cemented in place so that they don’t come off, and use a shoe horn to put the shoe on each time.

  • If a roomy toe box is not required, then place toe taps or half insoles under the footbed, or full-length orthotics to snug up the forefoot. You can do this on both shoes, or just one if the slippage is unilateral (often this is the case when one foot is shorter than the other).

  • In the case of a sulcus or ¾-length orthotic, cut the removable insole in half. Using just the forefoot section, drop the orthotic in place. This will ensure a deeper fit in the back along with a snug cushioned feel in the toe box.

  • In the case of an equinus/tight-calf individual, try adding a small heel lift on each side. You will lose heel depth, but the lift may help to counteract the early heel rise and subsequent heel slippage experienced from having tight heel cords.

  • Try different types of socks: thick vs thin, cotton vs synthetic, single vs double layer, etc.

  • In the case of a very stiff shoe, heel slippage is often inevitable, as the foot is trying to flex during toe off while the stiff shoe lags behind.

    • If stiffness is a recommended feature, then making sure the shoe has a good toe spring or rocker profile may be the only way to ensure a good heel fit.

    • If stiffness is not required, try to bend or ‘preflex’ the shoe to make it move better with the foot thus keeping  the heel in place.

There are no simple solutions to complex problems, and heel slippage is a complicated issue requiring multiple strategies and a variety of tools—as well as, of course, lots of patience.

Hope this helps!

Cheers!

Phil

[Photo credit: RunRepeat]

Hoka: A Modern Rocker for both Performance and Orthopaedics

One of the most intriguing shoes on the market comes by way of designers and adventure sports enthusiasts Jean -Luc Diard and Nicholas Mermoud.
Influenced by the popularity of wide tires and wide skis they created a line of trail runners with thick protective cushioning and a rockered profile. For a prototype they de-laminated a runner, separating the midsole/outsole from the upper. They then cut a piece of foam 2 1/2 times as thick as the foam of a regular running shoe, rockered the sole, patterned some tread and glued it back together.  The result is a somewhat bulky looking, yet surprisingly lightweight, line of shoes that delivers world class results in both athletics and orthopaedics.  Hoka One Ones are popular with the Ultra-Marathoners. They seem to deliver on the designer's goal of reducing fatigue, impact, and muscle strain over the long run. 
 At the same time rheumatoid arthritis sufferers can ambulate on a Hoka where they often experience significant forefoot pain in conventional flexible footwear. As you know, the Forefoot rocker is not a new invention.  It is used extensively in managing a variety of orthopaedic foot issues from post-surgery, to neuromas, to various forms of metatarsalgia. The problem is that a stiff rocker is usually only available in an uninspiring, unathletic, orthopaedic shoe. The Hoka provides a lightweight, well cushioned mainstream option.  I know... It sounds like another infomercial, but some firsthand experiences have proved compelling. Case in point:  Recently a 27-year-old female living in northern BC was brought into the store for some stiff rocker shoes. She entered alongside her occupational therapist from the GF Strong Rehab Centre. The patient had not walked comfortably for two years due to severe rheumatoid arthritis.  Her gait was painful, robotic, and thereby limiting.  After unsuccessfully trying on a few orthopaedic shoes, we tried the Hokas. A few careful steps later she began showing confidence in the rocker and fell into a more natural heel-toe gait pattern.  Knee and hip recruitment was a welcomed site to the therapist. The wide full ground contact base and stable rearfoot provided the patient with confidence and support while the forefoot
rocker allowed her to pass quickly through the painful metatarsals with limited flexion.  Unlike the Sketchers and MBT, the Hoka provides stable footing while the slight rearfoot rocker and 4 mm heel/ toe offset seems to promote a smooth heel- toe transition (be aware that the midsole foot frame sidewalls are firm and unusually high often restricting some wider based orthotics).  There is a second application for this shoe that may prove useful for runners and walkers. Case in point:  Forced to run with an acute calf strain I put on my Hokas (quite by accident really).  To my surprise, after 5 km, the calf was not aggravated at all which made me wonder:  Could it be, that with the rocker helping to get through toe off more quickly, meant less calf stress?  With less lower leg involvement, was there increased hip flexor, hamstring, and quad recruitment?  Does the increased use of the larger muscle groups during ambulation help explain why ultra-marathoners can go further in this type of shoe than any other?  
 Send us your thoughts... We’d love to hear them!  In the meantime, think of Hoka when looking for a lightweight rocker shoe for athletes and non-athletes alike.