Foot care guide · Foot and ankle · 6 min read

Most of us choose shoes in about three minutes. We pick a size, check they look right and feel fine in the shop. Then we wear them for ten hours a day, on hard floors, for years. It's not surprising that feet sometimes complain.

For people with bunions, tailor's bunions or heel pain, footwear isn't a detail. It can make the difference between a comfortable day and a miserable one. This guide explains what to look for in each case, why it matters and where shoes stop being the answer and specialist care begins.

Why shoes matter so much

Shoes don't usually cause these conditions on their own. Family history, foot shape and mechanics all play a part. But footwear decides how much pressure lands on a sensitive spot and how much stress goes through the tissue every step. Get it right and symptoms often ease. Get it wrong and a manageable problem becomes a painful one.

Bunions: room at the front

A bunion is a bony lump on the inner side of the foot at the base of the big toe, where the big toe drifts towards the others. According to Mr Pavel Akimau's website, more than a third of people over 65 have bunions, and women are affected about twice as often as men.

• A wide, deep toe box. The toes need space to spread, and the bump needs room not to be squashed.
• Soft, flexible uppers. Stiff leather or seams over the bunion cause rubbing and blisters.
• Low or moderate heels. Higher heels push body weight onto the front of the foot.
• Adjustable fastening. Laces or straps let you adapt to swelling during the day.

Soft pads and toe spacers can add protection. Footwear changes help comfort, but they don't straighten a bunion. For people whose bunions keep getting worse or keep limiting life, the conversation moves to surgery.

When you're weighing up a treatment for bunions, it helps to know that modern surgery is very different from the older, more invasive operations many people remember hearing about. Mr Akimau uses a minimally invasive technique, which involves cutting and repositioning the bones through small skin incisions with special instruments and implants. According to his website, many patients are delighted with how quick and comfortable the recovery has been. Everyone's experience differs, so ask what to expect in your own case.

Tailor’s bunions: protect the outside edge

A tailor's bunion, or bunionette, is a lump on the outer side of the foot at the base of the little toe. The name comes from tailors who used to sit cross-legged for hours with the outer edge of the foot pressed on the floor.

• A roomy forefoot. Narrow, pointed shoes press directly on the bump.
• Soft materials over the outside edge. Avoid hard seams or stiff overlays.
• Padding. A small cushioned pad can protect the area.
• Careful sizing. Shoes that are too short or narrow squeeze the little toe.

In most cases, tailor’s bunion treatment starts the same way: roomier footwear, padding and activity adjustments. If the lump stays painful despite these steps, a specialist assessment can confirm what's going on and whether any other option is appropriate.

Plantar fasciitis: support and cushioning

Plantar fasciitis is irritation of the thick band of tissue running from the heel to the toes. Pain is typically sharpest during the first steps in the morning. According to the same website, it affects around 1 in 10 people, most often active adults between 25 and 65.

• Decent cushioning. A thin, flat sole transmits more shock through the heel.
• Arch support. A supportive shape, or a suitable insole, helps spread the load.
• A slightly raised heel. Completely flat shoes can stretch the fascia more.
• Replace worn trainers. Cushioning breaks down well before the uppers look old.
• Avoid long barefoot spells on hard floors. Supportive slippers help at home.

Good footwear is one part of plantar fasciitis treatment, alongside regular stretching of the plantar fascia and calf, night splints and, for some people, injections or shock wave therapy. For the small number who still have pain after a long, proper trial, surgery can be a good option. According to Mr Akimau, the operation is straightforward, involves releasing a small band of tight tissue, and patients can walk immediately afterwards.

One shoe, three problems: where advice conflicts

When shoes aren't enough

See a specialist if pain has lasted more than a few weeks despite sensible changes, wakes you at night or limits walking, work or exercise. Seek prompt medical advice if you can't put weight on the foot, notice marked swelling, redness or warmth, develop numbness or feel unwell with a fever. Mr Akimau is a Consultant Orthopaedic Surgeon who has worked at University Hospitals of North Staffordshire NHS Trust since 2021 and consults in Staffordshire, Cheltenham and Bristol.

Frequently asked questions

Final thoughts

Comfortable feet start with comfortable shoes, and a few small changes often go a long way. If they don't, a specialist assessment can help you decide what to do next. To book a consultation with Mr Akimau, call 07934 539252 or 01782 432227, or email [email protected].

This article is for general information and isn't a substitute for personal medical advice.