The Best and Worst Shoes for Back Pain

It’s best to see your healthcare professional if you’ve had back pain for more than a month, your pain is worsening over time, or you’re developing new neurologic symptoms, such as numbness or weakness, in any part of your body. It’s also worth asking whether your footwear choices may be contributing to your back pain.

We spoke with two New York City–based podiatrists for their input on the best and worst shoes for back pain. Both doctors note that what works best for one person won’t necessarily work the same for others. For some people, for example, significant limb length differences can lead to problems that are exacerbated by wearing the wrong shoes.

But for many people, simply identifying shoes that fit well, are adequately cushioned, and provide the right kind of support is a step in the right direction.

What to Look for When Choosing Shoes

Shoes, sneakers, and other footwear should feel comfortable and not pinch or irritate any part of your foot, even when new. When you try on shoes, spend some time walking around in them and paying attention to how they feel. No matter how good they look, don’t buy shoes that are too tight, too loose, unsupportive, or in any way uncomfortable.

To raise your chances of finding a comfortable fit, here are some shoe characteristics to look for.

Moderate Heel Height

According to Pauline Fu, DPM, an assistant clinical professor of orthopedics at Mount Sinai hospital in New York City, shoes with a slight heel are best. The fact that your heels are slightly elevated allows your ankle to turn a little bit and rotate differently.

On the other hand, a heel that’s the same height as or lower than the toe of the shoe, affects the way your leg — and, in turn, your pelvis — turns. That, then, will affect your spine and lower back and cause back pain, Dr. Fu says.

What qualifies as a “slight” heel? Bryon Butts, DPM, of Performance Footcare of New York, points out that the guidelines from the American Podiatric Medical Association recommend something under 2 inches, and never anything higher than that.

Fu notes that 2-inch heels have been shown to alleviate the pressure on your feet while walking. The ideal range, she says, is between 1 and 2 inches. Anything over that will not be kind to your back.

While heel height is more typically a concern when it comes to women’s shoes, the concept of heel height as a positive feature applies to men as well, Fu says. That said, she also points out that most men’s shoes are neutral in heel height, so the heel and toe are on the same level — and that men have a lower incidence of back pain than women.

Cushioning and Shock Absorption

Some people strike the ground with their heel harder than others while walking, sending a shock up their legs and toward their backs. The problem can be exacerbated in those wearing dress shoes, but Fu and Dr. Butts note that a cork heel can help. The same goes for a rubber heel or wedge-style shoes, says Fu.

And both doctors agree that the sweet spot lies in the middle: a shoe that isn’t too hard or too soft.

When it comes to running shoes, “maximalist” footwear with a lot of cushioning has become big among ultramarathoners and people with a high-arch foot type, according to Butts, who specializes in sports medicine and treating foot and lower limb conditions in runners.

Rocker-Bottom Soles

Rocker-bottom soles aren’t for everyone, but they can be helpful in some situations. These feature thick soles that curve up at the front and sometimes the back of the shoe, enabling the foot to move through a normal walking motion with less pressure on the joints and on the bottom of the foot, generally.

Rocker-bottom soles are sometimes a feature of therapeutic shoes prescribed to people with diabetes-related foot problems, and they’ve also become more common in some models of sneakers and walking shoes marketed to the general public.

Fu notes that rocker-bottom sneakers with a thick rubber sole alleviate impact on the heel. Some of her patients find them to be helpful in dealing with plantar fasciitis, as well as with knee, hip, and back pain.

Sandals With Arch Support

But special, orthopedic-style sandals are an exception, says Fu. These do provide a proper amount of arch support, Butts agrees.

If you love sandals as daily footwear, a podiatrist should be able to help you identify which types would be best for you.

Shoes to Avoid if You’re Experiencing Back Pain

The longer you wear a pair of shoes, and the more standing or walking you intend to do in them, the more important it is that they offer good support where you need it. Here are some red flags when it comes to footwear:

Beware of Negative Heels

Fu explains that most flip-flops effectively lower your heel below your toes, creating a negative heel. Although she notes that they do offer some cushioning, she labels it “a false sense of cushioning,” because the sole of a flip-flop is typically not thick enough to absorb the shock of each step.

House slippers — which Butts refers to as “the worst thing for your back” — present all the same issues as flip-flops, but of course, few people are wearing slippers while out and about. So as long as you’re only wearing slippers in the house, you don’t need to worry too much about them.

Fu cautions against wearing anything that has a negative heel. That includes flat types of loafers and ballerina-type shoes with very flat soles. Shoes like these will rotate your pelvis in a way that can worsen back pain, she says.

Too Hard or Too Soft Is a Problem

Keeping in mind that you want some shock absorption in your shoes, it’s best to avoid footwear that’s “totally hard,” according to Fu. Typical dress shoes fall into this category, thanks to their lack of cushioning.

Perhaps surprisingly problematic are shoes with a memory foam or an air cushion, because they do not provide the right type of support along with their cushioning. However, when combined with a more supportive heel, these types of cushioning aren’t so bad for you.

Minimalist Shoes Are Usually Not Recommended

Minimalist shoes — sometimes called “barefoot” shoes because of their very thin soles — are not good for your back, says Fu. Those who already have back issues typically find that these types of shoes don’t help alleviate those problems and may cause some back pain.

Again, these shoes will rotate the pelvis differently than shoes with a thicker sole. For what it’s worth, Butts notes that when it comes to wearing minimalist shoes, it’s up to each person to decide what’s comfortable for them.

Casual Sneakers Can Lack Support

Butts also singles out casual sneakers, such as the classic Converse Chuck Taylor All-Stars, as problematic for being flat, narrow, and lacking support. He notes that Chucks were designed for feet in the 1950s — which, he says, were narrower than feet today. “People have just gotten bigger,” he says.

Where to Find Help in Choosing Your Shoes

If you need more personalized shoe recommendations, Fu recommends seeking out a podiatrist who is trained in biomechanics and can identify issues such as gait abnormalities.

Both doctors note that some shoe stores have trained staff who can make shoe recommendations based on foot shape as well as measurements.

Butts notes, however, that many podiatrists focus on surgery, and he recommends that people who need help selecting shoes also consider speaking to a pedorthist, a professional with training on fitting therapeutic footwear and orthotic devices.

A pedorthist specializes in using footwear — whether that be shoes, shoe modifications, braces, orthoses, or other pedorthic devices — to address foot-care problems. The Pedorthic Footcare Association features a Find a Pedorthist tool on its website to help you search for such a specialist near you.

Keep in mind that if you’re still having back pain in spite of wearing appropriate shoes, it may be time to investigate other reasons for your pain. Your primary care doctor is a good place to start when looking for signs of medical problems that might be causing back pain. They can discuss aspects of your lifestyle that may be contributing to it, and recommend changes you can make.